TY 2011 Form 990

(A) Name and business address	(B) Description of services	(C) Compensation
MCKESSON INFORMATION SOLUTIONS PO BOX 98347 CHICAGO,IL606938347	IT SUPPORT	3,910,610
LEBANON ANESTHESIA ASSOCIATION PO BOX 1281 LEBANON,PA17042	ANESTHESIOLOGISTS	3,213,873
LEBANON CARDIOLOGY ASSOCIATES 775 NORMAN DRIVE LEBANON,PA17042	CARDIOLOGISTS	2,185,300
REHAB CARE GROUP INC PO BOX 502096 ST LOUIS,MO631502098	REHAB MGMT SERVICES	1,291,264
SODEXO OPERATIONS LLC PO BOX 360170 PITTSBURGH,PA152516170	DIETARY MGMT SERVICE	965,437
2 Total number of independent contractors (including but not limited to those listed above) who received more than $100,000 of compensation from the organization 24

Do not include amounts reported on lines 6b, 7b, 8b, 9b, and 10b of Part VIII.	(A) Total expenses	(B) Program service expenses	(C) Management and general expenses	(D) Fundraising expenses
1	Grants and other assistance to governments and organizations in the United States. See Part IV, line 21	0
2	Grants and other assistance to individuals in the United States. See Part IV, line 22	22,900	22,900
3	Grants and other assistance to governments, organizations, and individuals outside the United States. See Part IV, lines 15 and 16	0
4	Benefits paid to or for members	0
5	Compensation of current officers, directors, trustees, and key employees ....	1,945,870		1,945,870
6	Compensation not included above, to disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B) ....	0
7	Other salaries and wages	55,758,965	47,395,120	8,363,845
8	Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) ....	4,520,237	3,842,201	678,036
9	Other employee benefits .......	7,434,885	6,319,652	1,115,233
10	Payroll taxes ...........	4,165,378	3,540,571	624,807
11	Fees for services (non-employees):
a	Management ......	0
b	Legal .........	219,971	186,975	32,996
c	Accounting ...........	218,000	185,300	32,700
d	Lobbying ...........	15,129	12,860	2,269
e	Professional fundraising. See Part IV, line 17..	0
f	Investment management fees ......	600,397	510,337	90,060
g	Other ..........	7,971,806	6,776,035	1,195,771
12	Advertising and promotion ....	1,331,219	1,131,536	199,683
13	Office expenses .......	1,728,769	1,469,454	259,315
14	Information technology ......	4,343,160	3,691,686	651,474
15	Royalties ..	0
16	Occupancy ...........	5,558,005	4,931,839	626,166
17	Travel ............	68,314	58,067	10,247
18	Payments of travel or entertainment expenses for any federal, state, or local public officials ......	0
19	Conferences, conventions, and meetings ....	181,709	154,453	27,256
20	Interest ...........	3,903,907	3,318,321	585,586
21	Payments to affiliates .......	1,511,796	1,285,027	226,769
22	Depreciation, depletion, and amortization .....	9,768,637	8,303,341	1,465,296
23	Insurance ..............	2,094,587	1,780,399	314,188
24	Other expenses. Itemize expenses not covered above (List miscellaneous expenses in line 24f. If line 24f amount exceeds 10% of line 25, column (A) amount, list line 24f expenses on Schedule O.)
a	MEDICAL SUPPLIES	31,139,419	31,139,419
b	BAD DEBT	12,066,975	12,066,975
c	PURCHASED SERVICES	11,486,512	9,763,535	1,722,977
d	TAXES	3,350,764	2,848,149	502,615
e
f	All other expenses	6,803,008	5,782,558	1,020,450
25	Total functional expenses. Add lines 1 through 24f	178,210,319	156,516,710	21,693,609	0
26	Joint costs. Complete this line only if the organization reported in column (B) joint costs from a combined educational campaign and fundraising solicitation. Check here if following SOP 98-2 (ASC 958-720).

Part X Balance Sheet
	1	Cashnon-interest-bearing ..........	5,370	1	5,220
2	Savings and temporary cash investments .......	2,403,439	2	2,272,501
3	Pledges and grants receivable, net .........	1,373,674	3	1,029,573
4	Accounts receivable, net .........	18,802,608	4	18,637,951
5	Receivables from current and former officers, directors, trustees, key employees, and highest compensated employees. Complete Part II of
	Schedule L ..........	0	5	0
6	Receivables from other disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B). Complete Part II of
	Schedule L ..........	0	6	0
7	Notes and loans receivable, net .............	1,153,750	7	1,130,188
8	Inventories for sale or use ..............	1,656,440	8	1,686,147
9	Prepaid expenses and deferred charges ............	2,464,927	9	2,851,253
10a	Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D	10a	186,994,825
b	Less: accumulated depreciation. .....	10b	117,407,607	73,244,003	10c	69,587,218
11	Investments—publicly traded securities ..........	29,142,551	11	29,850,306
12	Investments—other securities. See Part IV, line 11 ......	0	12	0
13	Investments—program-related. See Part IV, line 11 ..	0	13	0
14	Intangible assets .........	2,269,669	14	2,269,669
15	Other assets. See Part IV, line 11 ...........	17,387,124	15	15,094,741
16	Total assets. Add lines 1 through 15 (must equal line 34)...	149,903,555	16	144,414,767
	17	Accounts payable and accrued expenses .	13,289,408	17	18,574,578
18	Grants payable ..........	0	18	0
19	Deferred revenue ..........	327,222	19	375,508
20	Tax-exempt bond liabilities ..........	65,273,066	20	63,955,676
21	Escrow or custodial account liability. Complete Part IV of Schedule D..	0	21	0
22	Payables to current and former officers, directors, trustees, key employees, highest compensated employees, and disqualified
	persons. Complete Part II of Schedule L..........	0	22	0
23	Secured mortgages and notes payable to unrelated third parties ..	791,851	23	700,819
24	Unsecured notes and loans payable to unrelated third parties ....	3,593,583	24	2,871,683
25	Other liabilities (including federal income tax, payables to related third parties, and other liabilities not included on lines 17-24). Complete Part X of Schedule D.....	38,112,397	25	64,500,376
26	Total liabilities. Add lines 17 through 25.....	121,387,527	26	150,978,640
		Organizations that follow SFAS 117, check here and complete lines 27 through 29, and lines 33 and 34.
27	Unrestricted net assets .....	25,570,795	27	-9,283,282
28	Temporarily restricted net assets .....	2,273,056	28	2,047,232
29	Permanently restricted net assets .....	672,177	29	672,177
	Organizations that do not follow SFAS 117, check here and complete lines 30 through 34.
30	Capital stock or trust principal, or current funds .....		30
31	Paid-in or capital surplus, or land, building or equipment fund .....		31
32	Retained earnings, endowment, accumulated income, or other funds		32
33	Total net assets or fund balances .....	28,516,028	33	-6,563,873
34	Total liabilities and net assets/fund balances .....	149,903,555	34	144,414,767

- TIN:

SCHEDULE A
(Form 990 or 990EZ)

Department of the Treasury
Internal Revenue Service

Public Charity Status and Public Support

Complete if the organization is a section 501(c)(3) organization or a section
4947(a)(1) nonexempt charitable trust.

Attach to Form 990 or Form 990-EZ. right arrow

See separate instructions.

OMB No. 1545-0047

2011

Open to Public
Inspection

Name of the organization

Good Samaritan Hospital The

Employer identification number

23-0794160

Part I

Reason for Public Charity Status (All organizations must complete this part.) See instructions

The organization is not a private foundation because it is: (For lines 1 through 11, check only one box.)

A church, convention of churches, or association of churches. section 170(b)(1)(A)(i).

A school described in section 170(b)(1)(A)(ii). (Attach Schedule E.)

A hospital or a cooperative hospital service organization described in section 170(b)(1)(A)(iii).

A medical research organization operated in conjunction with a hospital described in section 170(b)(1)(A)(iii). Enter the hospital's name, city, and state:

An organization operated for the benefit of a college or university owned or operated by a governmental unit described in

section 170(b)(1)(A)(iv). (Complete Part II.)

A federal, state, or local government or governmental unit described in section 170(b)(1)(A)(v).

An organization that normally receives a substantial part of its support from a governmental unit or from the general public described in

section 170(b)(1)(A)(vi). (Complete Part II.)

A community trust described in section 170(b)(1)(A)(vi). (Complete Part II.)

An organization that normally receives: (1) more than 331/3% of its support from contributions, membership fees, and gross

receipts from activities related to its exempt functions—subject to certain exceptions, and (2) no more than 331/3% of

its support from gross investment income and unrelated business taxable income (less section 511 tax) from businesses

acquired by the organization after June 30, 1975. See section 509(a)(2). (Complete Part III.)

An organization organized and operated exclusively to test for public safety. Seesection 509(a)(4).

An organization organized and operated exclusively for the benefit of, to perform the functions of, or to carry out the purposes of one or more publicly supported organizations described in section 509(a)(1) or section 509(a)(2). See section 509(a)(3). Check the box that describes the type of supporting organization and complete lines 11e through 11h.

Type I

Type II

Type III - Functionally integrated

Type III - Other

By checking this box, I certify that the organization is not controlled directly or indirectly by one or more disqualified persons other than foundation managers and other than one or more publicly supported organizations described in section 509(a)(1) or section 509(a)(2).

If the organization received a written determination from the IRS that it is a Type I, Type II or Type III supporting organization, check this box ..................................................

Since August 17, 2006, has the organization accepted any gift or contribution from any of the
following persons?

(i) a person who directly or indirectly controls, either alone or together with persons described in (ii)

Yes

and (iii) below, the governing body of the the supported organization? ................

11g(i)

(ii) a family member of a person described in (i) above? ......................

11g(ii)

(iii) a 35% controlled entity of a person described in (i) or (ii) above? ................

11g(iii)

Provide the following information about the supported organization(s).

(i) Name of supported organization	(ii) EIN	(iv) Is the organization in col. (i) listed in your governing document?		(v) Did you notify the organization in col. (i) of your support?		(vi) Is the organization in col. (i) organized in the U.S.?		(vii) Amount of support?
(i) Name of supported organization	(ii) EIN	Yes	No	Yes	No	Yes	No	(vii) Amount of support?


Total

For Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 11285F

Schedule A (Form 990 or 990-EZ) 2011

Page 2

Part II

Support Schedule for Organizations Described in IRC 170(b)(1)(A)(iv) and 170(b)(1)(A)(vi)
(Complete only if you checked the box on line 5, 7, or 8 of Part I or if the organization failed to qualify under Part III. If the organization fails to qualify under the tests listed below, please complete Part III.)

Section A. Public Support

Calendar year(or fiscal year beginning in)		(a) 2007	(b) 2008	(c) 2009	(d) 2010	(e) 2011	(f) Total
1	Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") ....
2	Tax revenues levied for the organization's benefit and either paid to or expended on its behalf.......
3	The value of services or facilities furnished by a governmental unit to the organization without charge..
4	Total. Add lines 1 through 3..
5	The portion of total contributions by each person (other than a governmental unit or publicly supported organization) included on line 1 that exceeds 2% of the amount shown on line 11, column (f)..
6	Public Support. Subtract line 5 from line 4.

Section B. Total Support

Calendar year(or fiscal year beginning in)		(a) 2007	(b) 2008	(c) 2009	(d) 2010	(e) 2011	(f) Total
7	Amounts from line 4..
8	Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..
9	Net income from unrelated business activities, whether or not the business is regularly carried on..
10	Other income. (Explain in Part IV.) Do not include gain or loss from the sale of capital assets..
11	Total support (Add lines 7 through 10).

Gross receipts from related activities, etc. (See instructions.) ..................

First Five Years If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a 501(c)(3) organization,
check this box and stop here.......................................... right arrow

Section C. Computation of Public Support Percentage

Public Support Percentage for 2010 (line 6 column (f) divided by line 11 column (f)) .........

Public Support Percentage for 2009 Schedule A, Part II, line 14 ...............

16a

33 1/3% support test—2011. If the organization did not check the box on line 13, and line 14 is 33 1/3% or more, check this box
and stop here. The organization qualifies as a publicly supported organization ...................... right arrow

33 1/3% support test—2010. If the organization did not check the box on line 13 or 16a, and line 15 is 33 1/3% or more, check this
box and stop here. The organization qualifies as a publicly supported organization ..................... right arrow

17a

10%-facts-and-circumstances test—2011. If the organization did not check a box on line 13, 16a, or 16b and line 14
is 10% or more, and if the organization meets the "facts and circumstances" test, check this box and stop here. Explain
in Part IV how the organization meets the "facts and circumstances" test. The organization qualifies as a publicly supported
organization .................................................. right arrow

10%-facts-and-circumstances test—2010. If the organization did not check a box on line 13, 16a, 16b, or 17a and line
15 is 10% or more, and if the organization meets the "facts and circumstances" test, check this box and stop here.
Explain in Part IV how the organization meets the "facts and circumstances" test. The organization qualifies as a publicly
supported organization .............................................. right arrow

Private Foundation If the organization did not check a box on line 13, 16a, 16b, 17a or 17b, check this box and see
instructions ................................................... right arrow

Schedule A (Form 990 or 990-EZ) 2011

Page 3

Part III

Support Schedule for Organizations Described in IRC 509(a)(2)
(Complete only if you checked the box on line 9 of Part I or if the organization failed to qualify under Part II. If the organization fails to qualify under the tests listed below, please complete Part II.)

Section A. Public Support

Calendar year(or fiscal year beginning in)		(a) 2007	(b) 2008	(c) 2009	(d) 2010	(e) 2011	(f) Total
1	Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") .
2	Gross receipts from admissions, merchandise sold or services performed, or facilities furnished in any activity that is related to the organization's tax-exempt purpose......
3	Gross receipts from activities that are not an unrelated trade or business under section 513..
4	Tax revenues levied for the organization's benefit and either paid to or expended on its behalf...
5	The value of services or facilities furnished by a governmental unit to the organization without charge..
6	Total. Add lines 1 through 5.
7a	Amounts included on lines 1, 2, and 3 received from disqualified persons...
b	Amounts included on lines 2 and 3 received from other than disqualified persons that exceed the greater of $5,000 or 1% of the amount on line 13 for the year.
c	Add lines 7a and 7b..
8	Public Support (Subtract line 7c from line 6.)

Section B. Total Support

Calendar year (or fiscal year beginning in)		(a) 2007	(b) 2008	(c) 2009	(d) 2010	(e) 2011	(f) Total
9	Amounts from line 6...
10a	Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..
b	Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975.
c	Add lines 10a and 10b.
11	Net income from unrelated business activities not included in line 10b, whether or not the business is regularly carried on.
12	Other income. Do not include gain or loss from the sale of capital assets (Explain in Part IV.)
13	Total support (Add lines 9, 10c, 11 and 12.).

Section C. Computation of Public Support Percentage

Public Support Percentage for 2011 (line 8 column (f) divided by line 13 column (f)) .........

Public support percentage from 2010 Schedule A, Part III, line 15 ...............

Section D. Computation of Investment Income Percentage

Investment income percentage for 2011 (line 10c column (f) divided by line 13 column (f)) ......

Investment income percentage from 2010 Schedule A, Part III, line 17 .............

19a

33 1/3% support tests—2011. If the organization did not check the box on line 14, and line 15 is more than 33 1/3% and line 17 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization .......... right arrow

33 1/3% support tests—2010. If the organization did not check a box on line 14 or line 19a, and line 16 is more than 33 1/3% and line 18 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization .... right arrow

Private Foundation If the organization did not check a box on line 14, 19a or 19b, check this box and see instructions ..... right arrow

Schedule A (Form 990 or 990-EZ) 2011

Page 4

Part IV

Supplemental Information. Supplemental Information. Complete this part to provide the explanation required by Part II, line 10; Part II, line 17a or 17b; or Part III, line 12. Also complete this part for any additional information. (See instructions).

Facts And Circumstances Test

Explanation

Schedule A (Form 990 or 990-EZ) 2011

Additional Data

Software ID:
Software Version:

- TIN:

Schedule B
(Form 990, 990-EZ,
or 990-PF)

Department of the Treasury
Internal Revenue Service

Schedule of Contributors

Attach to Form 990, 990-EZ, or 990-PF.

OMB No. 1545-0047

2011

Name of organization

Good Samaritan Hospital The

Employer identification number

23-0794160

Organization type (check one):

Filers of:

Section:

Form 990 or 990-EZ

501(c)( ) (enter number) organization

4947(a)(1) nonexempt charitable trust not treated as a private foundation

527 political organization

Form 990-PF

501(c)(3) exempt private foundation

4947(a)(1) nonexempt charitable trust treated as a private foundation

501(c)(3) taxable private foundation

Check if your organization is covered by the General Rule or a Special Rule.
Note. Only a section 501(c)(7), (8), or (10) organization can check boxes for both the General Rule and a Special Rule. See instructions.

General Rule

For an organization filing Form 990, 990-EZ, or 990-PF that received, during the year, $5,000 or more (in money or
property) from any one contributor. Complete Parts I and II.

Special Rules

For a section 501(c)(3) organization filing Form 990 or 990-EZ that met the 33¹/3% support test of the regulations
under sections 509(a)(1) and 170(b)(1)(A)(vi), and received from any one contributor, during the year, a contribution of the
greater of (1) $5,000 or (2) 2% of the amount on (i) Form 990, Part VIII, line 1h, or (ii) Form 990-EZ, line 1. Complete Parts I and II.

For a section 501(c)(7), (8), or (10) organization filing Form 990, or 990-EZ that received from any one contributor,
during the year, total contributions of more than $1,000 for use exclusively for religious, charitable,
scientific, literary, or educational purposes, or the prevention of cruelty to children or animals. Complete Parts I, II, and
III.

For a section 501(c)(7), (8), or (10) organization filing Form 990, or 990-EZ that received from any one contributor,
during the year, contributions for use exclusively for religious, charitable, etc., purposes, but these contributions did
not total to more than $1,000. If this box is checked, enter here the total contributions that were received during
the year for an exclusively religious, charitable, etc., purpose. Do not complete any of the parts unless the General Rule
applies to this organization because it received nonexclusively religious, charitable, etc., contributions of $5,000 or more
during the year. ......................... Arrow Bullet

Caution. An Organization that is not covered by the General Rule and/or the Special Rules does not file Schedule B (Form 990,
990-EZ, or 990-PF), but it must answer “No” on Part IV, line 2, of its Form 990; or check the box on line H of its
Form 990-EZ or on Part I, line 2, of its Form 990-PF, to certify that it does not meet the filing requirements of Schedule B (Form 990,
990-EZ, or 990-PF).

For Paperwork Reduction Act Notice, see the Instructions
for Form 990, 990-EZ, or 990-PF.

Cat. No. 30613XSchedule B (Form 990, 990-EZ, or 990-PF) (2011)

Page 2

Name of organization Good Samaritan Hospital The
Schedule B (Form 990, 990-EZ, or 990-PF) (2011)
Part I	Contributors (see Instructions). Use duplicate copies of Part I if additional space is needed.
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
RESTRICTED	RESTRICTED RESTRICTED RESTRICTED RESTRICTED, RESTRICTED RESTRICTED	$RESTRICTED	Person Payroll Noncash (Complete Part II if there is a noncash contribution.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II if there is a noncash contribution.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II if there is a noncash contribution.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II if there is a noncash contribution.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II if there is a noncash contribution.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II if there is a noncash contribution.)
Schedule B (Form 990, 990-EZ, or 990-PF) (2011)

Page 3

Name of organization Good Samaritan Hospital The
Schedule B (Form 990, 990-EZ, or 990-PF) (2011)
Part II	Noncash Property (see Instructions). Use duplicate copies of Part II if additional space is needed.
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (see instructions).	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (see instructions).	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (see instructions).	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (see instructions).	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (see instructions).	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (see instructions).	(d) Date received
		$
Schedule B (Form 990, 990-EZ, or 990-PF) (2011)

Page 4

Schedule B (Form 990, 990-EZ, or 990-PF) (2011)

Name of organization
Good Samaritan Hospital The

Employer identification number

23-0794160

Part III

Exclusively religious, charitable, etc., individual contributions to section 501(c)(7), (8), or (10) organizations
that total more than $1,000 for the year. Complete columns (a) through (e) and the following line entry.
For organizations completing Part III, enter the total of exclusively religious, charitable, etc.,
contributions of $1,000 or less for the year. (Enter this information once. See instructions.) Arrow Bullet

$
Use duplicate copies of Part III if additional space is needed

(a) No.
from
Part I

(b)
Purpose of gift

(d)
Description of how gift is held

(e) Transfer of gift
Transferee's name, address, and ZIP 4	Relationship of transferor to transferee

(a) No.
from
Part I

(b)
Purpose of gift

(d)
Description of how gift is held

(e) Transfer of gift
Transferee's name, address, and ZIP 4	Relationship of transferor to transferee

(a) No.
from
Part I

(b)
Purpose of gift

(d)
Description of how gift is held

(e) Transfer of gift
Transferee's name, address, and ZIP 4	Relationship of transferor to transferee

(a) No.
from
Part I

(b)
Purpose of gift

(d)
Description of how gift is held

(e) Transfer of gift
Transferee's name, address, and ZIP 4	Relationship of transferor to transferee

Schedule B (Form 990, 990-EZ, or 990-PF) (2011)

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE C
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service

Political Campaign and Lobbying Activities

For Organizations Exempt From Income Tax Under section 501(c) and section 527
SchCMd Bullet

Complete if the organization is described below.
SchCMd Bullet

Attach to Form 990 or Form 990-EZ. SchCMd Bullet

See separate instructions.

OMB No. 1545-0047

2011

Open to Public
Inspection

If the organization answered “Yes” to Form 990, Part IV, Line 3, or Form 990-EZ, Part V, line 46 (Political Campaign Activities), then
Round Bullet

Section 501(c)(3) organizations: Complete Parts I-A and B. Do not complete Part I-C.
Round Bullet

Section 501(c) (other than section 501(c)(3)) organizations: Complete Parts I-A and C below. Do not complete Part I-B.
Round Bullet

Section 527 organizations: Complete Part I-A only.
If the organization answered “Yes” to Form 990, Part IV, Line 4, or Form 990-EZ, Part VI, line 47 (Lobbying Activities), then
Round Bullet

Section 501(c)(3) organizations that have filed Form 5768 (election under section 501(h)) Complete Part II-A. Do not complete Part II-B.
Round Bullet

Section 501(c)(3) organizations that have NOT filed Form 5768 (election under section 501(h)): Complete Part II-B. Do not complete Part II-A.
If the organization answered “Yes” to Form 990, Part IV, Line 5 (Proxy Tax) or Form 990-EZ, line 35c (Proxy Tax), then
Round Bullet

Section 501(c)(4), (5), or (6) organizations: Complete Part III.

Name of the organization

Good Samaritan Hospital The

Employer identification number

23-0794160

Part I-A

Complete if the organization is exempt under section 501(c) or is a section 527 organization.

Provide a description of the organization’s direct and indirect political campaign activities in Part IV.

Political expenditures .................................... SchCMd Bullet

Volunteer hours ........................................

Part I-B

Complete if the organization is exempt under section 501(c)(3).

Enter the amount of any excise tax incurred by the organization under section 4955 ......... SchCMd Bullet

Enter the amount of any excise tax incurred by organization managers under section 4955 ...... SchCMd Bullet

If the organization incurred a section 4955 tax, did it file Form 4720 for this year? ..............

Yes No

Was a correction made? .........................................

Yes No

If "Yes," describe in Part IV.

Part I-C

Complete if the organization is exempt under section 501(c) except section 501(c)(3).

Enter the amount directly expended by the filing organization for section 527 exempt function activities SchCMd Bullet

Enter the amount of the filing organization's funds contributed to other organizations for section 527 exempt function activities ................................... SchCMd Bullet

Total exempt function expenditures. Add lines 1 and 2. Enter here and on Form 1120-POL, line 17b.. SchCMd Bullet

Did the filing organization file Form 1120-POL for this year? ..........................

Yes No

Enter the names, addresses and employer identification number (EIN) of all section 527 political organizations to which the filing
organization made payments. For each organization listed, enter the amount paid from the filing organization’s funds. Also enter the amount of political contributions received that were promptly and directly delivered to a separate political organization, such as a separate segregated fund or a political action committee (PAC). If additional space is needed, provide information in Part IV.

(a) Name	(b) Address	(c) EIN	(d) Amount paid from filing organization's funds. If none, enter -0-.	(e) Amount of political contributions received and promptly and directly delivered to a separate political organization. If none, enter -0-.

For Privacy Act and Paperwork Reduction Act Notice, see the instructions for Form 990.

Cat. No. 50084S

Schedule C (Form 990 or 990-EZ) 2011

Page 2

Part II-A

Complete if the organization is exempt under section 501(c)(3) and filed Form 5768 (election under section 501(h)).

A Check if the filing organization belongs to an affiliated group (and list in Part IV each affiliated group member's name, address, EIN, expenses, and share of excess lobbying expenditures).
B Check if the filing organization checked box A and "limited control" provisions apply.

Limits on Lobbying Expenditures (The term "expenditures" means amounts paid or incurred.)		(b) Affiliated group totals
1a	Total lobbying expenditures to influence public opinion (grass roots lobbying) ......
b	Total lobbying expenditures to influence a legislative body (direct lobbying) .......
c	Total lobbying expenditures (add lines 1a and 1b) ...................
d	Other exempt purpose expenditures ........................
e	Total exempt purpose expenditures (add lines 1c and 1d) ...............
f	Lobbying nontaxable amount. Enter the amount from the following table in both columns.
	If the amount on line 1e, column (a) or (b) is:The lobbying nontaxable amount is:
	Not over $500,00020% of the amount on line 1e.
	Over $500,000 but not over $1,000,000$100,000 plus 15% of the excess over $500,000.
	Over $1,000,000 but not over $1,500,000$175,000 plus 10% of the excess over $1,000,000.
	Over $1,500,000 but not over $17,000,000$225,000 plus 5% of the excess over $1,500,000.
	Over $17,000,000$1,000,000.

g	Grassroots nontaxable amount (enter 25% of line 1f) .................
h	Subtract line 1g from line 1a. If zero or less, enter -0-. ................
i	Subtract line 1f from line 1c. If zero or less, enter -0-. ................
j	If there is an amount other than zero on either line 1h or line 1i, did the organization file Form 4720 reporting section 4911 tax for this year? ......................................	Yes No

4-Year Averaging Period Under Section 501(h) (Some organizations that made a section 501(h) election do not have to complete all of the five columns below. See the instructions for lines 2a through 2f on page 4.)
Lobbying Expenditures During 4-Year Averaging Period
	Calendar year (or fiscal year beginning in)	(a) 2008	(b) 2009	(c) 2010	(d) 2011	(e) Total

2a	Lobbying non-taxable amount

b	Lobbying ceiling amount (150% of line 2a, column(e))

c	Total lobbying expenditures

d	Grassroots nontaxable amount

e	Grassroots ceiling amount (150% of line 2d, column (e))

f	Grassroots lobbying expenditures

Schedule C (Form 990 or 990-EZ) 2011

Page 3

Part II-B

Complete if the organization is exempt under section 501(c)(3) and has NOT filed Form 5768 (election under section 501(h)).

For each “Yes” response to lines 1a through 1i below, provide in Part IV a detailed description of the lobbying activity.

(a)

Yes

(b)

Amount

During the year, did the filing organization attempt to influence foreign, national, state or local legislation, including any attempt to influence public opinion on a legislative matter or referendum, through the use of:

Volunteers? .........................................

Paid staff or management (include compensation in expenses reported on lines 1c through 1i)? ....

Media advertisements? ....................................

Mailings to members, legislators, or the public? .........................

Publications, or published or broadcast statements? .......................

Grants to other organizations for lobbying purposes? .......................

Direct contact with legislators, their staffs, government officials, or a legislative body? ........

Yes

15,129

Rallies, demonstrations, seminars, conventions, speeches, lectures, or any similar means? ......

Other activities? ..........................

Total. Add lines 1c through 1i ...............................

15,129

Did the activities in line 1 cause the organization to be not described in section 501(c)(3)? .....

If "Yes," enter the amount of any tax incurred under section 4912 .................

If "Yes," enter the amount of any tax incurred by organization managers under section 4912 .....

If the filing organization incurred a section 4912 tax, did it file Form 4720 for this year? .......

Part III-A

Complete if the organization is exempt under section 501(c)(4), section 501(c)(5), or section 501(c)(6).

Yes

Were substantially all (90% or more) dues received nondeductible by members? ................

Did the organization make only in-house lobbying expenditures of $2,000 or less? ................

Did the organization agree to carry over lobbying and political expenditures from the prior year? ..........

Part III-B

Complete if the organization is exempt under section 501(c)(4), section 501(c)(5), or section 501(c)(6) and if either (a) BOTH Part III-A, lines 1 and 2 are answered “No” OR (b) Part III-A, line 3 is answered “Yes”.

Dues, assessments and similar amounts from members .....................

Section 162(e) nondeductible lobbying and political expenditures (do not include amounts of political
expenses for which the section 527(f) tax was paid).

Current year .........................................

Carryover from last year ....................................

Total ...........................................

Aggregate amount reported in section 6033(e)(1)(A) notices of nondeductible section 162(e) dues .

If notices were sent and the amount on line 2c exceeds the amount on line 3, what portion of the excess does the organization agree to carryover to the reasonable estimate of nondeductible lobbying and political expenditure next year? ................................

Taxable amount of lobbying and political expenditures (see instructions) ..............

Part IV

Supplemental Information

Complete this part to provide the descriptions required for Part l-A, line 1; Part l-B, line 4; Part l-C, Part II-A; line 5; and Part ll-B, line 1.
Also, complete this part for any additional information.

Identifier	Return Reference	Explanation
LOBBYING ACTIVITIES	SCHEDULE C, PART II-B, LINE 1G	THE HOSPITAL HOLDS MEMBERSHIP IN THE AMERICAN HOSPITAL ASSOCIATION (AHA) AND THE HOSPITAL & HEALTHSYSTEM ASSOCIATION OF PENNSYLVANIA BOTH OF WHICH ENGAGE IN LOBBYING AS A PART OF THEIR MISSION TO REPRESENT THE INTERESTS OF HOSPITALS AT BOTH THE FEDERAL AND STATE LEVELS. FOR THE YEAR ENDED 6-30-12 THE AMOUNT OF DUES PAID TO THE HHAP TOTALED $65,781 WHICH 23% ($15,129) WAS USED FOR LOBBYING PURPOSES. ON OCCASION, HHAP REQUESTS THE HELP OF MEMBER PROVIDERS TO COMMUNICATE CONCERNS TO LEGISLATORS REGARDING PENDING LEGISLATION, WHICH COULD IMPACT HOSPITALS. THIS CAN INVOLVE DIRECT CONTACT WITH LEGISLATORS OR LETTER WRITING. THIS OCCURS INFREQUENTLY AND THE COST TO THE HOSPITAL IS NEGLIGIBLE.

Schedule C (Form 990 or 990EZ) 2011

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE D
(Form 990)

Department of the Treasury
Internal Revenue Service

Supplemental Financial Statements

Complete if the organization answered "Yes," to Form 990,
Part IV, line 6, 7, 8, 9, 10, 11a, 11b, 11c, 11d, 11e, 11f, 12a, or 12b
SchDMd Bullet

Attach to Form 990. SchDMd Bullet

See separate instructions.

OMB No. 1545-0047

2011

Open to Public Inspection

Name of the organization

Good Samaritan Hospital The

Employer identification number

23-0794160

Part I

Organizations Maintaining Donor Advised Funds or Other Similar Funds or Accounts. Complete if the organization answered "Yes" to Form 990, Part IV, line 6.

		(a) Donor advised funds	(b) Funds and other accounts
1	Total number at end of year .......
2	Aggregate contributions to (during year) ...
3	Aggregate grants from (during year) ...
4	Aggregate value at end of year .......

Did the organization inform all donors and donor advisors in writing that the assets held in donor advised
funds are the organization's property, subject to the organization's exclusive legal control? ............

Yes No

Did the organization inform all grantees, donors, and donor advisors in writing that grant funds can be
used only for charitable purposes and not for the benefit of the donor or donor advisor, or for any other purpose conferring impermissible private benefit? ...................................

Yes No

Part II

Conservation Easements. Complete if the organization answered "Yes" to Form 990, Part IV, line 7.

Purpose(s) of conservation easements held by the organization (check all that apply).

Preservation of land for public use (e.g., recreation or education) Preservation of an historically important land area

Protection of natural habitat Preservation of a certified historic structure

Preservation of open space

Complete lines 2a through 2d if the organization held a qualified conservation contribution in the form of a conservation easement on the last day of the tax year.


a	Total number of conservation easements .......................	2a
b	Total acreage restricted by conservation easements ..................	2b
c	Number of conservation easements on a certified historic structure included in (a) .....	2c
d	Number of conservation easements included in (c) acquired after 8/17/06, and not on a historic structure listed in the National Register ....................	2d

Number of conservation easements modified, transferred, released, extinguished, or terminated by the organization during
the tax year SchDMd Bullet

Number of states where property subject to conservation easement is located SchDMd Bullet

Does the organization have a written policy regarding the periodic monitoring, inspection, handling of violations, and
enforcement of the conservation easements it holds? .............................

Yes No

Staff and volunteer hours devoted to monitoring, inspecting and enforcing conservation easements during the year SchDMd Bullet

Amount of expenses incurred in monitoring, inspecting, and enforcing conservation easements during the year
SchDMd Bullet

Does each conservation easement reported on line 2(d) above satisfy the requirements of section
170(h)(4)(B)(i) and 170(h)(4)(B)(ii)? ....................................

Yes No

In Part XIV, describe how the organization reports conservation easements in its revenue and expense statement, and
balance sheet, and include, if applicable, the text of the footnote to the organization’s financial statements that describes
the organization’s accounting for conservation easements.

Part III

Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets.
Complete if the organization answered "Yes" to Form 990, Part IV, line 8.

If the organization elected, as permitted under SFAS 116 (ASC 958), not to report in its revenue statement and balance sheet works of
art, historical treasures, or other similar assets held for public exhibition, education or research in furtherance of public service,
provide, in Part XIV, the text of the footnote to its financial statements that describes these items.

If the organization elected, as permitted under SFAS 116 (ASC 958), to report in its revenue statement and balance sheet works of art,
historical treasures, or other similar assets held for public exhibition, education, or research in furtherance of public service,
provide the following amounts relating to these items:

(i)

Revenues included in Form 990, Part VIII, line 1 ........................ SchDMd Bullet

(ii)

Assets included in Form 990, Part X .............................. SchDMd Bullet

If the organization received or held works of art, historical treasures, or other similar assets for financial gain, provide the
following amounts required to be reported under SFAS 116 (ASC 958), relating to these items:

Revenues included in Form 990, Part VIII, line 1 .......................... SchDMd Bullet

Assets included in Form 990, Part X ............................... SchDMd Bullet

For Privacy Act and Paperwork Reduction Act Notice, see the Intructions for Form 990

Cat. No. 52283D

Schedule D (Form 990) 2011

Page 2

Part III

Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets (continued)

Using the organization’s accession and other records, check any of the following that are a significant use of its collection
items (check all that apply):

Public exhibition

Loan or exchange programs

Scholarly research

Other

Preservation for future generations

Provide a description of the organization’s collections and explain how they further the organization’s exempt purpose in
Part XIV.

During the year, did the organization solicit or receive donations of art, historical treasures or other similar
assets to be sold to raise funds rather than to be maintained as part of the organization’s collection?........

Yes No

Part IV

Escrow and Custodial Arrangements. Complete if the organization answered "Yes" to Form 990,
Part IV, line 9, or reported an amount on Form 990, Part X, line 21.

Is the organization an agent, trustee, custodian or other intermediary for contributions or other assets not
included on Form 990, Part X? ....................................

Yes No

If "Yes," explain the arrangement in Part XIV and complete the following table:


c	Beginning balance .................................	1c
d	Additions during the year ..............................	1d
e	Distributions during the year .............................	1e
f	Ending balance ...................................	1f

Did the organization include an amount on Form 990, Part X, line 21? .....................

Yes No

If “Yes,” explain the arrangement in Part XIV.

Part V

Endowment Funds. Complete if the organization answered "Yes" to Form 990, Part IV, line 10.

		(a)Current Year	(b)Prior Year	(c)Two Years Back	(d)Three Years Back
1a	Beginning of year balance ....	2,945,233	3,005,818	3,236,426	3,712,782
b	Contributions ........	424,618	834,833	458,155	-26,711
c	Net investment earnings, gains, and losses ...	53,135	26,652	36,900	-22,884
d	Grants or scholarships .....
e	Other expenditures for facilities and programs ........	703,577	922,070	725,663	426,761
f	Administrative expenses ....
g	End of year balance ......	2,719,409	2,945,233	3,005,818	3,236,426

Provide the estimated percentage of the year end balance (line 1g) held as:

Board designated or quasi-endowment SchDMd Bullet

0 %

Permanent endowment SchDMd Bullet

24.720 %

Temporarily restricted endowment SchDMd Bullet

75.280 %

The percentages in lines 2a, 2b, and 2c should equal 100%.

Are there endowment funds not in the possession of the organization that are held and administered for the
organization by:

Yes

(i) unrelated organizations ........................

3a(i)

(ii) related organizations ........................

3a(ii)

If "Yes" to 3a(ii), are the related organizations listed as required on Schedule R? .........

Describe in Part XIV the intended uses of the organization's endowment funds.

Part VI

Land, Buildings, and Equipment. See Form 990, Part X, line 10.

Description of property		(b)Cost or other basis (other)	(c) Accumulated depreciation	(d) Book value
1a	Land .................	1,468,847		1,468,847
b	Buildings ................	89,594,063	40,035,289	49,558,774
c	Leasehold improvements ............	3,782,430	3,155,023	627,407
d	Equipment ................	89,589,473	72,679,639	16,909,834
e	Other .................	2,560,012	1,537,656	1,022,356
Total. Add lines 1a through 1e. (Column (d) must equal Form 990, Part X, column (B), line 10(c).).......				69,587,218

Schedule D (Form 990) 2011

Page 3

Part VII

InvestmentsOther Securities. See Form 990, Part X, line 12.

(a) Description of security or category (including name of security)		(b)Book value	(c) Method of valuation: Cost or end-of-year market value
(1)Financial derivatives
(2)Closely-held equity interests
Other








Total. (Column (b) must equal Form 990, Part X, col. (B) line 12.)

Part VIII

InvestmentsProgram Related. See Form 990, Part X, line 13.

(a) Description of investment type		(b) Book value	(c) Method of valuation: Cost or end-of-year market value









Total. (Column (b) must equal Form 990, Part X, col.(B) line 13.)

Part IX

Other Assets. See Form 990, Part X, line 15.

(a) Description				(b) Book value
(1) ACCRUED INT BOARD DESIG FUNDS				2,000
(2) DEBT SVC FUNDS NON-CURRENT				5,656,510
(3) DEBT SVC FUNDS CURRENT				1,390,000
(4) INTERCOMPANY RECEIVABLES				215,396
(5) DUE FROM FOUNDATION				72,804
(6) DUE FROM EMPL, STAFF, PHYS				98,354
(7) OTHER RECEIVABLES				410,212
(8) MALPRACTICE INSURANCE REC				2,333,702
(9) DEFERRED BOND ISSUE COSTS				611,481
(10) OTHER ASSETS				4,304,282
Total. (Column (b) must equal Form 990, Part X, col.(B) line 15.)...........				15,094,741

Part X

Other Liabilities. See Form 990, Part X, line 25.

1.(a) Description of Liability		(b) Book value
Federal Income Taxes		0
EMPLOYEE W/H PAYABLE		505,481
3RD PARTY PAYABLES		4,540,487
LONG TERM POST RETIRE BENEFITS		2,927,137
INSURANCE RESERVES		3,777,267
PENSION LIABILITY		52,750,004




Total. (Column (b) must equal Form 990, Part X, col.(B) line 25.)		64,500,376
2. Fin 48 (ASC 740) Footnote. In Part XIV, provide the text of the footnote to the organization's financial statements that reports the organization's liability for uncertain tax positions under FIN 48 (ASC740).

Schedule D (Form 990) 2011

Page 4

Part XI Reconciliation of Change in Net Assets from Form 990 to Financial Statements
1	Total revenue (Form 990, Part VIII, column (A), line 12) ....................	1	179,795,357
2	Total expenses (Form 990, Part IX, column (A), line 25) .....................	2	178,210,319
3	Excess or (deficit) for the year. Subtract line 2 from line 1 .............	3	1,585,038
4	Net unrealized gains (losses) on investments ..........................	4	-240,114
5	Donated services and use of facilities .............................	5
6	Investment expenses ...................................	6
7	Prior period adjustments ..................................	7
8	Other (Describe in Part XIV.) .................................	8	-36,424,825
9	Total adjustments (net). Add lines 4 through 8 .........................	9	-36,664,939
10	Excess or (deficit) for the year per financial statements. Combine lines 3 and 9 .........	10	-35,079,901

Part XII Reconciliation of Revenue per Audited Financial Statements With Revenue per Return
1	Total revenue, gains, and other support per audited financial statements .......			1	179,321,646
2	Amounts included on line 1 but not on Form 990, Part VIII, line 12:
a	Net unrealized gains on investments ..........	2a	-240,114
b	Donated services and use of facilities .........	2b
c	Recoveries of prior year grants ...........	2c
d	Other (Describe in Part XIV.) ............	2d	-477,755
e	Add lines 2a through 2d .....................			2e	-717,869
3	Subtract line 2e from line 1.....................			3	180,039,515
4	Amounts included on Form 990, Part VIII, line 12, but not on line 1:
a	Investment expenses not included on Form 990, Part VIII, line 7b .	4a
b	Other (Describe in Part XIV.) ...........	4b	-244,158
c	Add lines 4a and 4b.......................			4c	-244,158
5	Total Revenue. Add lines 3 and 4c. (This must equal Form 990, Part I, line 12.) ......			5	179,795,357

Part XIII Reconciliation of Expenses per Audited Financial Statements With Expenses per Return
1	Total expenses and losses per audited financial statements .............			1	178,454,477
2	Amounts included on line 1 but not on Form 990, Part IX, line 25:
a	Donated services and use of facilities ..........	2a
b	Prior year adjustments ..............	2b
c	Other losses ................	2c
d	Other (Describe in Part XIV.) ............	2d	244,158
e	Add lines 2a through 2d......................			2e	244,158
3	Subtract line 2e from line 1.....................			3	178,210,319
4	Amounts included on Form 990, Part IX, line 25, but not on line 1:
a	Investment expenses not included on Form 990, Part VIII, line 7b ..	4a
b	Other (Describe in Part XIV.) ............	4b
c	Add lines 4a and 4b.......................			4c
5	Total expenses. Add lines 3 and 4c. (This must equal Form 990, Part I, line 18.) ......			5	178,210,319

Part XIV

Supplemental Information

Complete this part to provide the descriptions required for Part II, lines 3, 5, and 9; Part III, lines 1a and 4; Part lV, lines 1b and 2b;
Part V, line 4; Part X; Part XI, line 8; Part XII, lines 2d and 4b; and Part XIII, lines 2d and 4b. Also complete this part to provide any additional information.

Identifier	Return Reference	Explanation
ENDOWMENT FUNDS	SCHEDULE D, PART V, LINE 4	THE GOOD SAMARITAN HOSPITAL MAINTAINS TEMPORARILY RESTRICTED AND PERMANENTLY RESTRICTED ASSETS TO PURCHASE SPECIFIC PIECES OF EQUIPMENT AND PROVIDE QUALIFIED APPLICANTS A SCHOLARSHIP.
RECONCILIATION	SCHEDULE D, PART XI, XII, XIII	PART XI, LINE 8 THE GOOD SAMARITAN HOSPITAL NEEDED TO RESERVE MONEY IN ORDER TO PROVIDE THE RETIRED EMPLOYEES AND FUTURE RETIRED EMPLOYEES WITH SUFFICIENT PENSION PAYMENTS. THE GOOD SAMARITAN HOSPITAL WAS ABLE TO RELEASE FUNDS THAT WERE RESTRICTED FOR A SPECIFIC PURPOSE. THE GOOD SAMARITAN HOSPITAL ALSO WROTE OFF A LARGE RECEIVABLE THAT WAS DUE FROM AN AFFILIATED EXEMPT ORGANIZATION, GOOD SAMARITAN PHYSICIAN SERVICES. THE AMOUNT OF THE PENSION RESERVE ADJUSTMENT WAS $27,651,540 AND THE AMOUNT OF THE WRITEOFF FOR THE GOOD SAMARITAN PHYSICIAN SERVICES RECEIVABLE WAS $8,748,175. THERE WAS ALSO A $25,110 CHANGE IN UNRESTRICTED NET ASSETS TO RECALCULATE THE BOYER ANNUITY LIABILITY. PART XII, LINE 2D LESS TEMPORARILY RESTRICTED CONTRIBUTIONS OF $424,618. ALSO LESS TEMPORARILY RESTRICTED INCOME FROM INVESTMENTS OF $53,137. PART XII, LINE 4B RENTAL EXPENSES OF $244,158 PART XIII, LINE 2D RENTAL EXPENSES OF $244,158 PART X, LINE 2 ASC 740 (FORMERLY FIN 48) IN THE COURSE OF PREPARING THE HOSPITAL'S TAX RETURNS, THE HOSPITAL EVALUATES TAX POSITIONS TAKEN OR EXPECTED TO BE TAKEN TO DETERMINE WHETHER THE TAX POSITIONS ARE "MORE-LIKELY-THAN-NOT" OF BEING SUSTAINED BY THE APPLICABLE TAX AUTHORITIES. TAX POSITIONS NOT DEEMED TO MEET THE MORE-LIKELY-THAN-NOT THRESHOLD ARE RECORDED AS TAX BENEFITS OR EXPENSE IN THE CURRENT YEAR. MANAGEMENT HAS ANALYZED ALL TAX POSITIONS TAKEN ON FEDERAL, STATE, AND LOCAL INCOME TAX RETURNS FOR ALL OPEN TAX YEARS AND HAS CONCLUDED THAT NO PROVISION FOR FEDERAL INCOME TAX IS REQUIRED IN THE FINANCIAL STATEMENTS. THERE ARE NO INTEREST AND PENALTIES DEDUCTED IN THE CURRENT PERIOD AND NO INTEREST AND PENALTIES ACCRUED AT JUNE 30, 2012.

Schedule D (Form 990) 2011

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE H (Form 990)

Department of the Treasury
Internal Revenue Service

Hospitals

Complete if the organization answered "Yes" to Form 990, Part IV, question 20.
MediumBullet

Attach to Form 990. MediumBullet

See separate instructions.

OMB No. 1545-0047

2011

Open to Public Inspection

Name of the organization

Good Samaritan Hospital The

Employer identification number

23-0794160

Part I

Charity Care and Certain Other Community Benefits at Cost

Yes

Did the organization have a financial assistance policy during the tax year? If "No," skip to question 6a....

Yes

If "Yes," was it a written policy? .......................

Yes

If the organization had multiple hospital facilities, indicate which of the following best describes application of the financial assistance policy to its various hospital facilities during the tax year.

Applied uniformly to all hospital facilities Applied uniformly to most hospital facilities Generally tailored to individual hospital facilities

Answer the following based on the financial assistance eligibility criteria that applied to the largest number of the organization's patients during the tax year.

Did the organization use Federal Poverty Guidelines (FPG) to determine eligibility for providing free care?

If "Yes," indicate which of the following was the FPG family income limit for eligibility for free care:

Yes

100% 150% 200% Other

Did the organization use FPG to determine eligibility for providing discounted care? If "Yes," indicate which of the

following was the family income limit for eligibility for discounted care: ............

Yes

200% 250% 300% 350% 400% Other

If the organization did not use FPG to determine eligibility, describe in Part VI the income based criteria for determining eligibility for free or discounted care. Include in the description whether the organization used an asset test or other threshold, regardless of income, to determine eligibility for free or discounted care.

Did the organization's financial assistance policy that applied to the largest number of its patients during the tax year provide for free or discounted care to the "medically indigent"? ..............

Yes

Did the organization budget amounts for free or discounted care provided under its financial assistance policy during the tax year? ............................

Yes

If "Yes," did the organization's financial assistance expenses exceed the budgeted amount?......

Yes

If "Yes" to line 5b, as a result of budget considerations, was the organization unable to provide free or discountedcare to a patient who was eligibile for free or discounted care?...............

Did the organization prepare a community benefit report during the tax year?...........

Yes

If "Yes," did the organization make it available to the public? ...............

Yes

Complete the following table using the worksheets provided in the Schedule H instructions. Do not submit these worksheets with the Schedule H.

Financial Assistance and Certain Other Community Benefits at Cost

	(c) Total community benefit expense	(d) Direct offsetting revenue	(e) Net community benefit expense	(f) Percent of total expense
a Financial Assistance at cost (from Worksheet 1) ..	1,819,202		1,819,202	1.090 %
b Medicaid (from Worksheet 3, column a) .....	2,969,712	1,389,416	1,580,296	0.950 %
c Costs of other means-tested government programs (from Worksheet 3, column b) .	14,082,079	6,666,614	7,415,465	4.460 %
dTotal Financial Assistance and Means-Tested Government Programs .....	18,870,993	8,056,030	10,814,963	6.500 %
Other Benefits e Community health improvement services and community benefit operations (from (Worksheet 4) ....	71,762		71,762	0.040 %
f Health professions education (from Worksheet 5) ..	2,140,330	931,524	1,208,806	0.730 %
g Subsidized health services (from Worksheet 6) ..
h Research (from Worksheet 7)
i Cash and in-kind contributions for community benefit (from Worksheet 8) ....
jTotal Other Benefits ...	2,212,092	931,524	1,280,568	0.770 %
kTotal. Add lines 7d and 7j. ..	21,083,085	8,987,554	12,095,531	7.270 %

For Paperwork Reduction Act Notice, see the Instructions for Form 990. Cat. No. 50192T Schedule H (Form 990) 2011

Schedule H (Form 990) 2011

Page

Part II

Community Building Activities Complete this table if the organization conducted any community building activities during the tax year, and describe in Part VI how its community building activities promoted the health of the communities it serves.

		(c) Total community building expense	(e) Net community building expense	(f) Percent of total expense
1	Physical improvements and housing
2	Economic development
3	Community support	32,293	32,293	0.020 %
4	Environmental improvements
5	Leadership development and training for community members	25,480	25,480	0.010 %
6	Coalition building
7	Community health improvement advocacy
8	Workforce development
9	Other
10	Total	57,773	57,773	0.030 %

Part III

Bad Debt, Medicare, & Collection Practices

Section A. Bad Debt Expense

Yes

Did the organization report bad debt expense in accordance with Heathcare Financial Management Association Statement No. 15? ..........................

Yes

Enter the amount of the organization's bad debt expense........

12,066,975

Enter the estimated amount of the organization's bad debt expense attributable to patients eligible under the organization's financial assistance policy .....

6,339,649

Provide in Part VI the text of the footnote to the organization's financial statements that describes bad debt expense. In addition, describe the costing methodology used in determining the amounts reported on lines 2 and 3, and rationale for including a portion of bad debt amounts as community benefit.

Section B. Medicare

Enter total revenue received from Medicare (including DSH and IME).....

34,644,838

Enter Medicare allowable costs of care relating to payments on line 5.....

78,222,253

Subtract line 6 from line 5. This is the surplus or (shortfall)........

-43,577,415

Describe in Part VI the extent to which any shortfall reported in line 7 should be treated as community benefit.Also describe in Part VI the costing methodology or source used to determine the amount reported on line 6.Check the box that describes the method used:

Cost accounting system Cost to charge ratio Other

Section C. Collection Practices

Did the organization have a written debt collection policy during the tax year? ..........

Yes

If "Yes," did the organization’s collection policy that applied to the largest number of its patients during the tax year contain provisions on the collection practices to be followed for patients who are known to qualify for financial assistance? Describe in Part VI.......................

Yes

Part IV

Management Companies and Joint Ventures

(see instructions)

(a) Name of entity	(b) Description of primary activity of entity	(c) Organization's profit % or stock ownership %	(d) Officers, directors, trustees, or key employees' profit % or stock ownership%	(e) Physicians' profit % or stock ownership %
1
2
3
4
5
6
7
8
9
10
11
12
13

Schedule H (Form 990) 2011

Page

Part VFacility Information

Section A. Hospital Facilities (list in order of size from largest to smallest) How many hospital facilities did the organization operate during the tax year?1 Name and address		Other (Describe)
1	THE GOOD SAMARITAN HOSPITAL FOURTH AND WALNUT STREETS LEBANON,PA17042	X	X	X	X

Schedule H (Form 990) 2011

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Part VFacility Information (continued)

Section B. Facility Policies and Practices.

(Complete a separate Section B for each of the hospital facilities listed in Part V, Section A)

THE GOOD SAMARITAN HOSPITAL

Name of Hospital Facility:

Line Number of Hospital Facility (from Schedule H, Part V, Section A):1

				Yes	No
Community Health Needs Assessment (Lines 1 through 7 are optional for 2011)
1	During the tax year or any prior tax year, did the hospital facility conduct a community health needs assessment (“Needs Assessment”)? If “No,” skip to question 8. .....................		1
	If “Yes,” indicate what the Needs Assessment describes (check all that apply):
	a	A definition of the community served by the hospital facility
	b	Demographics of the community
	c	Existing health care facilities and resources within the community that are available to respond to the health needs of the community
	d	How data was obtained
	e	The health needs of the community
	f	Primary and chronic disease needs and other health issues of uninsured persons, low-income persons, and minority groups
	g	The process for identifying and prioritizing community health needs and services to meet the community health needs
	h	The process for consulting with persons representing the community’s interests
	i	Information gaps that limit the hospital facility’s ability to assess the community’s health needs
	j	Other (describe in Part VI)
2	Indicate the tax year the hospital facility last conducted a Needs Assessment: 20
3	In conducting its most recent Needs Assessment, did the hospital facility take into account input from persons who represent the community served by the hospital facility? If “Yes,” describe in Part VI how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted.		3
4	Was the hospital facility’s Needs Assessment conducted with one or more other hospital facilities? If “Yes,” list the other hospital facilities in Part VI............................		4
5	Did the hospital facility make its Needs Assessment widely available to the public? ...........		5
	If “Yes,” indicate how the Needs Assessment was made widely available (check all that apply):
	a	Hospital facility’s website
	b	Available upon request from the hospital facility
	c	Other (describe in Part VI)
6	If the hospital facility addressed needs identified in its most recently conducted Needs Assessment, indicate how (check all that apply):
	a	Adoption of an implementation strategy to address the health needs of the hospital facility’s community
	b	Execution of the implementation strategy
	c	Participation in the development of a community-wide community benefit plan
	d	Participation in the execution of a community-wide community benefit plan
	e	Inclusion of a community benefit section in operational plans
	f	Adoption of a budget for provision of services that address the needs identified in the Needs Assessment
	g	Prioritization of health needs in the community
	h	Prioritization of services that the hospital facility will undertake to meet health needs in its community
	i	Other (describe in Part VI)
7	Did the hospital facility address all of the needs identified in its most recently conducted Needs Assessment? If “No,” explain in Part VI which needs it has not addressed and the reasons why it has not addressed such needs. ....		7
Financial Assistance Policy
	Did the hospital facility have in place during the tax year a written financial assistance policy that:
8	Explained eligibility criteria for financial assistance, and whether such assistance includes free or discounted care?		8	Yes
9	Used federal poverty guidelines (FPG) to determine eligibility for providing free care?...........		9	Yes
	If "Yes," indicate the FPG family income limit for eligibility for free care: 200.% If "No," explain in Part VI the criteria the hospital facility used.

Schedule H (Form 990) 2011

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Part VFacility Information (continued)

				Yes	No
10	Used FPG to determine eligibility for providing discounted care?.................		10	Yes
	If “Yes,” indicate the FPG family income limit for eligibility for discounted care: 300.% If "No," explain in Part VI the criteria the hospital facility used.
11	Explained the basis for calculating amounts charged to patients?.................		11	Yes
	If “Yes,” indicate the factors used in determining such amounts (check all that apply):
	a	Income level
	b	Asset level
	c	Medical indigency
	d	Insurance status
	e	Uninsured discount
	f	Medicaid/Medicare
	g	State regulation
	h	Other (describe in Part VI)
12	Explained the method for applying for financial assistance?...................		12	Yes
13	Included measures to publicize the policy within the community served by the hospital facility?.......		13	Yes
	If “Yes,” indicate how the hospital facility publicized the policy (check all that apply):
	a	The policy was posted on the hospital facility’s web site
	b	The policy was attached to all billing invoices
	c	The policy was posted in the hospital facility’s emergency rooms or waiting rooms
	d	The policy was posted in the hospital facility’s admissions offices
	e	The policy was provided, in writing, to patients upon admission to the hospital facility
	f	The policy was available upon request
	g	Other (describe in Part VI)
Billing and Collections
14	Did the hospital facility have in place during the tax year a separate billing and collections policy, or a written financial assistance policy (FAP) that explained actions the hospital facility may take upon non-payment?.......		14	Yes
15	Check all of the following collection actions against an individual that were permitted under the hospital facility's policies during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP:
	a	Reporting to credit agency
	b	Lawsuits
	c	Liens on residences
	d	Body attachments
	e	Other similar actions (describe in Part VI)
16	Did the hospital facility or an authorized third party perform any of the following actions during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP?..........		16		No
	If “Yes,” check all actions in which the hospital facility or a third party engaged:
	a	Reporting to credit agency
	b	Lawsuits
	c	Liens on residences
	d	Body attachments
	e	Other similar actions (describe in Part VI)
17	Indicate which efforts the hospital facility made before initiating any of the actions checked in line 16 (check all that apply):
	a	Notified patients of the financial assistance policy upon admission
	b	Notified patients of the financial assistance policy prior to discharge
	c	Notified patients of the financial assistance policy in communications with the patients regarding the patients’ bills
	d	Documented its determination of whether patients were eligible for financial assistance under the hospital facility’s financial assistance policy
	e	Other (describe in Part VI)

Schedule H (Form 990) 2011

Page

Part VFacility Information (continued)

Policy Relating to Emergency Medical Care
				Yes	No
18	Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that requires the hospital facility to provide, without discrimination, care for emergency medical conditions to individuals regardless of their eligibility under the hospital facility’s financial assistance policy?..........		18	Yes
	If “No,” indicate why:
	a	The hospital facility did not provide care for any emergency medical conditions
	b	The hospital facility’s policy was not in writing
	c	The hospital facility limited who was eligible to receive care for emergency medical conditions (describe in Part VI)
	d	Other (describe in Part VI)
Individuals Eligible for Financial Assistance
19	Indicate how the hospital facility determined, during the tax year, the maximum amounts that can be charged to FAP-eligible individuals for emergency or other medically necessary care.
	a	The hospital facility used its lowest negotiated commercial insurance rate when calculating the maximum amounts that can be charged
	b	The hospital facility used the average of it's three lowest negotiated commercial insurance rates when calculating the maximum amounts that can be charged
	c	The hospital facility used the Medicare rates when calculating the maximum amounts that can be charged
	d	Other (describe in Part VI)
20	Did the hospital facility charge any of its patients who were eligible for assistance under the hospital facility’s financial assistance policy, and to whom the hospital facility provided emergency or other medically necessary services, more than the amounts generally billed to individuals who had insurance covering such care?.........		20		No
	If “Yes,” explain in Part VI.
21	Did the hospital facility charge any of its FAP-eligible patients an amount equal to the gross charge for any services provided to that patient?...............................		21	Yes
	If “Yes,” explain in Part VI.

Schedule H (Form 990) 2011

Page

Part VFacility Information (continued)

Section C. Other Health Care Facilities That Are Not Licensed, Registered, or Similarly Recognized as a Hospital Facility (list in order of size, from largest to smallest) How many non-hospital health care facilities did the organization operate during the tax year?11
Name and address		Type of Facility (describe)
1	THE GOOD SAMARITAN HOSPITAL FOURTH AND WILLOW STREETS LEBANON,PA17042	REHAB AND TCU UNITS
2	THE GOOD SAMARITAN HOSPITAL 830 TUCK STREET LEBANON,PA17042	OUTPATIENT SURGICAL CENTER
3	THE GOOD SAMARITAN HOSPITAL 840 TUCK STREET LEBANON,PA17042	WOUND CARE & HYPERBARIC CENTER
4	THE GOOD SAMARITAN HOSPITAL 206 HATHAWAY PARK LEBANON,PA17042	SLEEP DISORDERS CENTER
5	THE GOOD SAMARITAN HOSPITAL 805 HELEN DRIVE LEBANON,PA17042	OUTPATIENT RADIOLOGY CENTER
6	THE GOOD SAMARITAN HOSPITAL 750 NORMAN DRIVE LEBANON,PA17042	BLOOD DONOR CENTER & LABORATORY
7	THE GOOD SAMARITAN HOSPITAL 297 WEST LINCOLN AVENUE MYERSTOWN,PA17067	OUTPATIENT DIAGNOSTIC CENTER
8	THE GOOD SAMARITAN HOSPITAL 1400 SOUTH FORGE ROAD PALMYRA,PA17078	AMBULATORY SERVICES CENTER
9	THE GOOD SAMARITAN HOSPITAL 100 QUEEN STREET JONESTOWN,PA17038	SATELLITE SERVICES CENTER
10	THE GOOD SAMARITAN HOSPITAL 950 ISABEL DRIVE LEBANON,PA17042	OUTPATIENT PHYSICAL THERAPY
11	THE GOOD SAMARITAN HOSPITAL 781 NORMAN DRIVE LEBANON,PA17042	CARDIOVASCULAR DIAGNOSTIC CENTER

Schedule H (Form 990) 2011

Page

Part VI

Supplemental Information

Complete this part to provide the following information.

1	Required descriptions. Provide the descriptions required for Part I, lines 3c, 6a, and 7; Part II; Part III, lines 4, 8, and 9b; and Part V, Section B, lines 1j, 3, 4, 5c, 6i, 7, 9, 10, 11h, 13g, 15e, 16e, 17e, 18d, 19d, 20, and 21.
2	Needs assessment. Describe how the organization assesses the health care needs of the communities it serves, in addition to any needs assessments reported in Part V, Section B.
3	Patient education of eligibility for assistance. Describe how the organization informs and educates patients and persons who may be billed for patient care about their eligibility for assistance under federal, state, or local government programs or under the organization’s financial assistance policy.
4	Community information. Describe the community the organization serves, taking into account the geographic area and demographic constituents it serves.
5	Promotion of community health. Provide any other information important to describing how the organization’s hospital facilities or other health care facilities further its exempt purpose by promoting the health of the community (e.g., open medical staff, community board, use of surplus funds, etc.).
6	Affiliated health care system. If the organization is part of an affiliated health care system, describe the respective roles of the organization and its affiliates in promoting the health of the communities served.
7	State filing of community benefit report. If applicable, identify all states with which the organization, or a related organization, files a community benefit report.

Identifier	ReturnReference	Explanation
COMMUNITY BENEFIT REPORT	PART I, LINE 6A	OUR ANNUAL COMMUNITY BENEFIT REPORT IS PREPARED BY OUR MARKETING DEPARTMENT. THE REPORT CAN BE FOUND AT OUR WEBSITE, WWW.GSHLEB.ORG. WE ALSO MAIL THE REPORT OUT TO THE MEMBERS OF OUR COMMUNITY.
PART I, LINE 7, COLUMN (F)		OUR TOTAL EXPENSE FROM FORM 990, PART IX, LINE 25, COLUMN (A) WAS $178,210,319. THE BAD DEBT EXPENSE INCLUDED IN THIS AMOUNT WAS $12,066,975. THIS LEFT US WITH A TOTAL EXPENSE OF $166,143,344 FOR PURPOSES OF CALCULATING LINE 7, COLUMN (F). PART I, LINE 7 THE GOOD SAMARITAN HOSPITAL USED THE COST TO CHARGE RATIO COST METHODOLOGY TO CALCULATE THE CHARITY AND UNREIMBURSED MEDICAID AND OTHER GOVERNMENT PROGRAMS. THE HOSPITAL USED DIRECT COSTS FOR THE OTHER COMMUNITY BENEFITS ON LINE 7.
COMMUNITY BUILDING ACTIVITIES	PART II	THE GOOD SAMARITAN HEALTH SYSTEM IS INVOLVED IN SOME COMMUNITY BUILDING PROGRAMS WHICH ARE DESIGNED TO "IMPROVE THE OVERALL HEALTH OF OUR COMMUNITY" (MISSION STATEMENT). THE GSH PARTICIPATES IN A DISASTER PREPAREDNESS PROGRAM WHICH PROVIDES A PLAN IN THE CASE OF A DISASTER THAT AFFECTS THE COMMUNITY. THE GSH ALSO PROVIDES SPACE FOR SUPPORT GROUPS TO MEET AND EDUCATION CLASSES FOR PEOPLE WITHIN THE COMMUNITY, LIKE EXPECTANT PARENTS. THE ACTIVITIES ARE NOT INCLUDED ELSEWHERE ON the SCHEDULE H.
BAD DEBT, MEDICARE, & COLLECTION PRACTICES	PART III, LINE 4	AFS FOOTNOTE: THE HOSPITAL ESTABLISHES AN ALLOWANCE FOR DOUBTFUL ACCOUNTS TO REPORT THE NET REALIZABLE AMOUNTS TO BE RECEIVED FROM PATIENTS. INCREASES TO THIS ALLOWANCE ARE REFLECTED AS A PROVISION FOR DOUBTFUL ACCOUNTS IN THE STATEMENTS OF OPERATIONS. THE HOSPITAL REGULARLY PERFORMS A DETAILED ANALYSIS OF THE COLLECTIBILITY OF PATIENT ACCOUNTS RECEIVABLE AND CONSIDERS SUCH FACTORS AS PRIOR COLLECTION EXPERIENCE AND THE AGE OF THE RECEIVABLES TO DETERMINE THE APPROPRIATE ALLOWANCE LEVEL. BAD DEBT METHODOLOGY: THE GOOD SAMARITAN HOSPITAL IS A TAX-EXEMPT NON-FOR-PROFIT HOSPITAL THAT PROVIDES QUALITY MEDICAL SERVICES TO PATIENTS REGARDLESS OF THEIR ABILITY TO PAY. BY PROVIDING MEDICAL SERVICES TO ALL COMMUNITY MEMBERS REGARDLESS OF THEIR ABILITY TO PAY, THE HOSPITAL'S BAD DEBT EXPENSE QUALIFIES AS A COMMUNITY BENEFIT. THE BAD DEBT EXPENSE CALCULATED ON LINE 2 WAS CALCULATED USING THE PATIENT CARE COST TO CHARGES METHODOLOGY. THE GOOD SAMARITAN HOSPITAL USES AN AUTOMATED SYSTEM CALLED PRESUMPTIVE TO CHARITY CARE TOOL TO CALCULATE THE AMOUNT ON LINE 3. ALL THE SELF PAY ACCOUNTS AND ALL THE SELF PAY AFTER INSURANCE ACCOUNTS ARE IMPORTED INTO THE TOOL, THEN THE TOOL SCORES EACH ACCOUNT BASED ON THE GOVERNMENT GUIDELINES FOR POVERTY LEVELS. FOR FYE 6/30/12, THE TOOL ESTIMATED THAT $6,339,649 OF THE ORGANIZATION'S BAD DEBT EXPENSE SHOULD BE CONSIDERED CHARITY CARE. PART III, LINE 8 MEDICARE ALLOWABLE COSTS WERE CALCULATED USING A COST TO CHARGE RATIO. THE GOOD SAMARITAN HOSPITAL PROVIDES QUALITY MEDICAL SERVICES TO ALL PATIENTS REGARDLESS OF WHAT INSURANCE THEY HAVE. APPROXIMATELY 58% OF THE GOOD SAMARITAN HOSPITAL'S REVENUE IS ATTRIBUTABLE TO MEDICARE PATIENTS. THE GOOD SAMARITAN HOSPITAL IS RELIEVING THE GOVERNMENT'S BURDEN, BECAUSE THE HOSPITAL IS PROVIDING SERVICES TO MEDICARE PATIENTS WHICH COST MORE THAN THE MEDICARE REIMBURSEMENT. THEREFORE, THE $43,577,415 MEDICARE SHORTFALL SHOULD BE CONSIDERED A COMMUNITY BENEFIT. PART III, LINE 9B COLLECTION POLICIES ARE THE SAME FOR ALL PATIENTS. IF A PATIENT NOTIFIES THE HOSPITAL ABOUT THEIR INABILITY TO PAY, THE HOSPITAL WILL SEND THEM THE CHARITY CARE AND FINANCIAL ASSISTANCE FORMS TO FILL OUT. ONCE THE FORMS ARE COMPLETED AND RETURNED TO THE HOSPITAL AND THE PATIENT QUALIFIES FOR FINANCIAL ASSISTANCE, THEN THE PATIENT'S ACCOUNT WILL BE REMOVED FROM COLLECTIONS AND THE ACCOUNT WILL BE WRITTEN OFF.
FACILITY INFORMATION	PART V, SECTION B, Q. 11H	THE GOOD SAMARITAN HOSPITAL CALCULATES THE AMOUNT CHARGED TO A PATIENT BASED ON CATESTROPHIC OR PHYSICAL HARDSHIP AND THE NUMBER OF INDIVIDUALS LIVING IN A HOUSEHOLD. PART V, SECTION B, Q. 19D THE GOOD SAMARITAN HOSPITAL BILLS INDIVIDUALS WITHOUT INSURANCE THEIR GROSS CHARGES ASSOCIATED WITH THE SERVICES THEY RECEIVED DURING THEIR VISIT. GSH OFFERS ALL SELF PAY PATIENTS A 35% DISCOUNT IF THEY PAY THEIR BILL WITHIN 30 DAYS OF THEIR SERVICES. PART V, SECTION B, Q. 21 THE GOOD SAMARITAN HOSPITAL CHARGES ITS SELF PAY PATIENTS THEIR GROSS CHARGES FOR THE SERVICES RENDERED.
NEEDS ASSESSMENT	PART VI, LINE 2	THE GOOD SAMARITAN HOSPITAL HAS PARTICIPATED IN A VARIETY OF COMMUNITY HEALTH NEEDS ASSESSMENTS OVER THE PAST 17 YEARS. THE HOSPITAL WAS INSTRUMENTAL IN HELPING TO LAUNCH THE COMMUNITY HEALTH COUNCIL OF LEBANON COUNTY. IN PARTNERSHIP WITH THE COUNCIL, A COMMUNITY HEALTH NEEDS ASSESSMENT WAS CREATED 17 YEARS AGO AND AN UPDATED ASSESSMENT COMPLETED 12 YEARS AGO. ANOTHER ASSESSMENT WAS CREATED IN 2005, LED BY EFFORTS OF THE UNITED WAY OF LEBANON COUNTY. THE GOOD SAMARITAN HOSPITAL IS CURRENTLY PARTNERED WITH OTHER COMMUNITY ORGANIZATIONS AND COMPLETED A COMMUNITY HEALTH ASSESSMENT DURING THE FALL OF 2011. THE HOSPITAL ALSO MAINTAINS AN INDEPENDENT, COUNTYWIDE PHYSICIAN NEEDS ASSESSMENT TO EVALUATE GAPS IN HEALTHCARE ACCESS. A NEW PHYSICIAN NEEDS ASSESSMENT WAS ALSO COMPLETED IN 2011. IN ADDITION TO THESE COUNTYWIDE EFFORTS, THE HOSPITAL HAS PERFORMED A VARIETY OF STUDIES ON SPECIFIC HEALTH CONCERNS AND COMMUNITY NEEDS. KEY STUDIES HAVE INCLUDED SERVICES FOR CARDIOVASCULAR, ONCOLOGY, GASTROENTEROLOGY, WOUND CARE, AND MORE. THE HOSPITAL HAS ALSO ACTED TO FULFILL THE NEEDS IDENTIFIED IN THESE STUDIES. THE HOSPITAL CREATED ONE OF THE NATION'S LEADING CARDIAC AND VASCULAR CENTERS, WHICH HAS EARNED SEVERAL NATIONAL AWARDS FOR QUALITY OF CARE. THE HOSPITAL INTRODUCED A NEW WOUND CARE SERVICE TO DEAL WITH PATIENTS SUFFERING FROM COMPLICATIONS OF DIABETES - A PARTICULAR PROBLEM TO LEBANON COUNTY - AND HAS ALREADY EXPANDED OPERATIONS TO ADD A THIRD HYPERBARIC OXYGEN TREATMENT CHAMBER TO THE TWO ORIGINALLY INSTALLED IN THE CENTER. IN ADDITION, THE HOSPITAL HAS PROTECTED THE COMMUNITY BY RECRUITING NEW PHYSICIANS FOR KEY SERVICES - GENERAL SURGERY, ONCOLOGY, AND GASTROENTEROLOGY - ALLOWING PATIENTS TO GET ACCESS TO CARE IN LEBANON COUNTY INSTEAD OF TRAVELING THROUGHOUT THE REGION. PART VI, LINE 3 THE GOOD SAMARITAN HOSPITAL CHARITY CARE POLICY OUTLINES THE PROCESS OF FINANCIAL, MEDICAL AND CATASTROPHIC CATEGORIES WHERE A PATIENT COULD QUALIFY FOR CHARITY CARE. THE HOSPITAL HAS A SELF PAY BROCHURE AVAILABLE THAT PROVIDES INFORMATION ON OUR CHARITY CARE PROGRAM ALONG WITH CONTACT INFORMATION AND AVAILABLE HOURS. FINANCIAL COUNSELORS ARE ON SITE TO MEET WITH PATIENTS TO DISCUSS THEIR FINANCIAL OBLIGATIONS, ASSIST THEM IN COMPLETING THE APPLICATION FOR CHARITY CARE, AND ANSWER THEIR QUESTIONS. PATIENTS ARE ENCOURAGED TO APPLY FOR CHARITY CARE IF THEY ARE UNABLE TO COME IN FOR AN APPOINTMENT. THERE IS A NOTE ON THE STATEMENTS THAT IS MAILED TO PATIENTS, LETTING THEM KNOW THAT FINANCIAL ASSISTANCE IS AVAILABLE. THE GOOD SAMARITAN HOSPITAL'S WEBSITE ALSO PROVIDES THE CONTACT INFORMATION FOR THOSE COMMUNITY MEMBERS WHO NEED MEDICAL SERVICES AND FINANCIAL ASSISTANCE. PART VI, LINE 4 LEBANON COUNTY INCLUDES A MIX OF URBAN, SUBURBAN, AND RURAL AREAS. THE CITY OF LEBANON IS CENTRALLY LOCATED, SERVING AS THE COUNTY SEAT. THE CITY IS HOME TO MORE THAN 24,000 RESIDENTS AND IS CLASSIFIED BY THE COMMONWEALTH OF PENNSYLVANIA AS A THIRD CLASS CITY. THE COUNTY INCLUDES 25 OTHER MUNICIPALITIES. THE REST OF THE COUNTY IS MADE UP OF SUBURBAN AND RURAL AREAS, WITH RURAL FARMLAND PROVIDING A DOMINANT CHARACTER OF COUNTY LIFE. WHILE MOST OF THE POPULATION TENDS TO BE OF WHITE ANCESTRY (91%), THE COUNTY HAS A FAST-GROWING HISPANIC POPULATION (7.8%) THAT CENTERS IN THE CITY OF LEBANON (SOURCE: US CENSUS BUREAU). THE US CENSUS BUREAU ALSO REPORTS THAT 8% OF THE POPULATION SPEAKS A LANGUAGE OTHER THAN ENGLISH AT HOME. EMPLOYMENT RATES IN THE COUNTY ARE CURRENTLY AT 6.8%- ONE OF THE LOWEST RATES IN THE STATE- AND AVERAGE HOUSEHOLD INCOME IS AT $50,334 ACCORDING TO THE USDA ECONOMIC RESEARCH SERVICE. THE FEDERAL GOVERNMENT IS THE COUNTY'S LARGEST EMPLOYER, WITH LARGE WORK FORCES AT THE LEBANON VETERANS ADMINISTRATION HOSPITAL AND FORT INDIANTOWN GAP. THE GOOD SAMARITAN HOSPITAL IS THE LARGEST NON-GOVERNMENTAL EMPLOYER WITH 1,500 EMPLOYEES. ACCORDING TO THE US CENSUS BUREAU AMERICAN COMMUNITY SURVEY, 8% OF THE POPULATION LIVES IN POVERTY. THE GOOD SAMARITAN HOSPITAL IS THE ONLY HOSPITAL IN LEBANON COUNTY. THE HOSPITAL PROVIDES EMERGENCY CARE TO APPROXIMATELY 54,000 INDIVIDUALS EACH YEAR. THE HOSPITAL CARED FOR 8,139 ACUTE CARE PATIENTS. IN ADDITION, THE HOSPITAL HAS PERFORMED THOUSANDS OF OUTPATIENT PROCEDURES- FROM SURGERIES TO IMAGING TO LABORATORY TO PHYSICAL THERAPY- EVERY YEAR. THE HOSPITAL ALSO PROVIDES A CONTINUITY OF CARE THROUGH A SKILLED NURSING UNIT, REHABILITATION SERVICES, HOME HEALTHCARE, AND HOSPICE CARE. THE HOSPITAL IS THE LARGEST PROVIDER OF CARE TO MEDICAID AND MEDICARE POPULATIONS. WHILE MOST LEBANON COUNTY RESIDENTS CHOOSE TO STAY IN THE COUNTY FOR THEIR CARE, WITH MORE THAN 60% CHOOSING THE GOOD SAMARITAN HOSPTIAL FOR SERVICES. ACCORDING TO THE ROBERT WOOD JOHNSON FOUNDATION COMMUNITY HEALTH RANKINGS, LEBANON COUNTY IS THE 13TH MOST HEALTHY OF PENNSYLVANIA'S 67 COUNTIES. THE HEALTH RANKINGS INDICATE KEY AREAS OF IMPROVEMENT, INCLUDING DIABETES, TOBACCO USE, AND OTHER HEALTH BEHAVIORS THAT ARE PROBLEMATIC. THE HOSPTIAL HAS TAKEN STEPS TO ADDRESS THESE AREAS BY EXPANDING SERVICES AND EDUCATIONAL OPPORTUNITIES.
COMMUNITY BENEFIT REPORT	PART VI, LINE 5	Good Samaritan strives to deliver powerful medicine with comforting care every day. As part of our non-profit mission, The Good Samaritan Hospital and its affiliated organizations deliver healthcare services that improve the quality of life throughout the region. As Lebanon County's only hospital, Good Samaritan is the community's primary - and sometimes only - resource for -Inpatient hospital care -Emergency care -Surgical services -Digestive health services -Maternity services -Cardiac & Vascular services -Radiology and medical imaging services -Laboratory diagnostic services and blood bank -Physical and occupational therapies -Transitional care and rehabilitation services -Home health and hospice services -Wound care and hyperbaric medicine -Dialysis -Sleep disorders -Physician services for needed specialties including cardiac, gastroenterology, general surgery, hematology, hospitalists, oncology, pediatrics, primary care (particularly for Medicaid population), thoracic, vascular, and wound care. -Medical residency program to train new physicians -And many more Community Benefit Total $579,401 GOOD SAMARITAN AND ITS EMPLOYEES DONATE MANY HOURS OF TIME TO IMPROVE THE HEALTH OF THE COMMUNITY. IN 2012, KEY PROJECTS INCLUDED HEALTH FAIRS: THE COUNTYWIDE 50+ FESTIVAL AND INDIVIDUAL EVENTS HOSTED BY VARIOUS NURSING AND RETIREMENT FACILITIES, EMPLOYERS AND OTHER COMMUNITY GROUPS EDUCATION PROGRAMS: OFFERED AT THE HOSPITAL OR PRESENTED TO COMMUNITY GROUPS ON TOPICS SUCH AS SMOKING CESSATION, CARDIAC HEALTH, CANCER PREVENTION, SLEEP DISORDERS, DIABETIC HEALTH, AND MORE MEDICAL CLINIC: GOOD SAMARITAN DONATED EMPLOYEE TIME TO SUPPORT A NEW INDEPENDENT MEDICAL CLINICS FOR POOR AND LOW-INCOME PATIENTS HEALTH SCREENINGS: SCREENINGS FOR SKIN CANCER, BLOOD PRESSURE, VARICOSE VEINS AND OTHER HEALTH CONDITIONS WERE PROVIDED THROUGHOUT THE YEAR. CHARITABLE AND UNCOMPENSATED CARE IN REFLECTION OF OUR NON-PROFIT MISSION, GOOD SAMARITAN DELIVERED $17.5 MILLION DOLLARS IN CHARITABLE AND UNCOMPENSATED CARE TO THE COMMUNITY. ECONOMIC IMPACT IN ADDITION TO OUR CORE HEALTHCARE MISSION, GOOD SAMARITAN IS LEBANON COUNTY'S LARGEST NON-GOVERNMENT EMPLOYER - AND POSITIVELY IMPACTS THE ECONOMY BY GENERATING MORE THAN 1,000 JOBS OUTSIDE OF THE HEALTH SYSTEM. THE GOOD SAMARITAN HOSPITAL HAD A NET HOSPITAL REVENUE OF $165 MILLION IN 2012. SERVICE STATISTICS: THE GOOD SAMARITAN HOSPITAL TREATED 8,893 PATIENTS IN 2012. IN ADDITION, THE HEALTH SYSTEM OFFERS A WIDE VARIETY OF DIAGNOSTIC AND NON-ACUTE HEALTH SERVICES THAT ARE NEEDED BY THE COMMUNITY. MANY OF THESE SERVICES WOULD NOT BE AVAILABLE TO THE COMMUNITY IF THEY WERE NOT OFFERED BY GOOD SAMARITAN. BEHIND THE STATISTICS: THE GOOD SAMARITAN EMERGENCY DEPARTMENT IS ONE OF THE REGION'S BUSIEST AND HAS ONE OF THE LOWEST WAIT TIMES. IT OPERATES THE ONLY EMERGENCY ROOM IN THE COUNTY. TO HELP IMPROVE COMMUNITY CARE, THE GOOD SAMARITAN HOSPITAL HAS INVESTED TO UPGRADE TO DIGITAL PRE-HOSPITAL EKG SOFTWARE. THIS ALLOWS THE EMERGENCY DEPARTMENT TO RECEIVE REAL-TIME, DIGITAL EKG READINGS BEFORE THE PATIENT ARRIVES AT THE HOSPITAL. THE JOINT VENTURE WITH FIRST AID & SAFETY OF LEBANON ORIGINATED IN 2006 WITH THE DEPLOYMENT OF EKG EQUIPMENT IN THE FIELD. A PATIENT EXPERIENCING CHEST PAIN WOULD RECEIVE AN EKG ON THE SCENE AND THE RESULTS WERE FAXED TO THE EMERGENCY DEPARTMENT. DUE TO THE JOINT VENTURE WITH FIRST AID & SAFETY, THE GOOD SAMARITAN HOSPITAL EMERGENCY DEPARTMENT NOW INTERACTS WITH SIX EKG MACHINES DEPLOYED TO THE UNITS IN THE COUNTY. THE DATA TRANSMITTED BY THE UNITS IS READ BY A PHYSICIAN WHO DETERMINES WHETHER OR NOT THE PATIENT WILL REQUIRE CARDIAC CATHETERIZATION. THIS ALLOWS THE HOSPITAL TO ACTIVATE THE CATHETERIZATION LAB RESPONSE TEAM PRIOR TO THE PATIENT'S ARRIVAL. BECAUSE THE DATA IS TRANSMITTED DIGITALLY, GOOD SAMARITAN CLINICIANS ARE ABLE TO RECEIVE THE INFORMATION MUCH FASTER AND SIGNIFICANTLY DECREASE OUR CARDIAC DOOR-TO-BALLOON TIME. THIS CREATES BETTER OUTCOMES FOR THE PATIENTS BECAUSE THEY ARE RECEIVING CRUCIAL CARE MUCH SOONER. SUPPORTING OUR COMMUNITY: THE EMPLOYEES OF THE GOOD SAMARITAN HEALTH SYSTEM HAVE A SPIRIT OF GENEROSITY. EACH YEAR EMPLOYEES DONATE THEIR TIME, GOODS AND MONEY TO SUPPORT WORTHY CAUSES. UNITED WAY - GOOD SAMARITAN EMPLOYEES DONATE MORE THAN $30,000 ANNUALLY TO THE UNITED WAY OF LEBANON COUNTY. REACH OUT AND READ - A NATIONAL PROGRAM TO GIVE FREE BOOKS TO CHILDREN OF LOW INCOME FAMILIES. CRIBS FOR KIDS - BRAND NEW CRIBS PROVIDED TO LOW-INCOME FAMILIES BRIDGE OF LOVE - PERSONAL CARE ITEMS PROVIDED TO FAMILIES IN NEED CAR SEATS - NEW CAR SEATS ARE MADE AVAILABLE TO LOW-INCOME FAMILIES AMERICAN HEART ASSOCIATION - MORE THAN 100 EMPLOYEES PARTICIPATE IN THE ANNUAL HEART WALK, RAISING THOUSANDS OF DOLLARS EACH YEAR OPERATION GOOD SAM - DURING THE THANKSGIVING FOOD DRIVE, FOOD IS COLLECTED AND DELIVERED TO MORE THAN 100 FAMILIES IN NEED. GOOD SAMARITAN CHRISTMAS TOY DRIVE - EMPLOYEES DONATE TOYS THAT ARE DELIVERED TO MORE THAN 250 CHILDREN EACH YEAR TO SPREAD HOLIDAY CHEER. COMMUNITY HEALTH COUNCIL THE GOOD SAMARITAN HOSPITAL HELPED TO CREATE THE INDEPENDENT COMMUNITY HEALTH COUNCIL OF LEBANON COUNTY. FROM ITS HUMBLE INCEPTION, THE COUNCIL HAS GROWN INTO A PREMIER COUNTY ORGANIZATION. MORE THAN 400 VOLUNTEERS COLLABORATE ON PROGRAMS TO INCREASE HEALTHY LIFESTYLES AND TO ELIMINATE ALCOHOL AND DRUG ABUSE IN THE COUNTY. THE COUNCIL SPONSORS PROGRAMS THAT ADDRESS THE SPECIAL NEEDS OF YOUTH, PARENTS AND SENIORS. A HOME FOR COMMUNITY GROUPS: THE GOOD SAMARITAN HOSPITAL OPENS ITS DOORS TO SUPPORT A VARIETY OF COMMUNITY GROUPS. THE HOSPITAL PROVIDES RENT-FREE CLASSROOM SPACE FOR A VARIETY OF SUPPORT GROUPS SUCH AS: -ALCOHOLICS ANONYMOUS -ALANON -BETTER BREATHER'S CLUB -NARCOTICS ANONYMOUS -JOURNEY THROUGH GRIEF BEREAVEMENT SUPPORT (ADULT FOCUSED HOSPICE SUPPORT) -SUPPORT AND HELP IN AIRING AND RESOLVING EXPERIENCES (FOR GRIEVING PARENTS) -RAINBOW CONNECTION (TEEN FOCUSED HOSPICE SUPPORT) -I CAN COPE (CANCER SUPPORT) -LELECHE LEAGUE SHARING OUR KNOWLEDGE: AT GOOD SAMARITAN HEALTH SYSTEM, CARING FOR OUR COMMUNITY EXTENDS BEYOND PROVIDING MEDICAL SERVICES. THROUGH OUR EDUCATIONAL SERVICES DEPARTMENT, WE OFFER CLASSES AND SUPPORT GROUPS THAT ADDRESS MULTIPLE HEALTH RELATED TOPICS, WHICH IN TURN OFFER THE MEMBERS OF OUR COMMUNITY AN OPPORTUNITY TO IMPROVE THEIR HEALTH, BOTH PHYSICALLY AND EMOTIONALLY. THE EDUCATIONAL SERVICES DEPARTMENT OVERSEES COMMUNITY EDUCATION CLASSES SUCH AS BABYSITTER TRAINING AND A VARIETY OF HEARTSAVER CPR PROGRAMS, WHICH RANGE FROM BASIC FIRST AID TO ADVANCED CARDIAC LIFE SUPPORT. THESE CLASSES PROVIDE INDIVIDUALS A CHANCE TO OBTAIN SKILLS WHICH CAN BENEFIT THEIR LIVES BOTH PERSONALLY AND PROFESSIONALLY. DIABETES IS PROMINENT IN THE LEBANON COUNTY. TO ADDRESS THIS GROWING HEALTH CONCERN, GOOD SAMARITAN OFFERS DIABETIC EDUCATION CLASSES. THIS PROGRAM IS A SERIES OF FOUR CLASSES WHICH ADDRESSES TOPICS SUCH AS: THE IMPORTANCE OF MANAGING DIABETES; MEAL PLANNING; USE OF MEDICATION; GLUCOSE MONITORING; AND COPING WITH DIABETES. COMMUNITY MEMBERS DEALING WITH SUBSTANCE ADDICTION OR THOSE WHO ARE GRIEVING CAN RECEIVE MUCH NEEDED SUPPORT THROUGH COMMUNITY GROUPS WHOSE MEETINGS ARE SCHEDULED THROUGH THE EDUCATIONAL SERVICES DEPARTMENT. THESE INCLUDE: AL-ANON; JOURNEY THROUGH GRIEF; NARCOTICS ANONYMOUS; AND SMOKE STOPPERS. MOST OF THESE PROGRAMS ARE OFFERED ON A WEEKLY OR BI-WEEKLY BASIS AND ALL ARE FREE OF CHARGE. IN ADDITION TO OFFERING CLASSES TO THE GENERAL PUBLIC, THE EDUCATIONAL SERVICES DEPARTMENT ALSO ASSISTS IN THE COORDINATION OF NURSING STUDENT CLINICAL ROTATIONS. WORKING IN CONJUNCTION WITH HARRISBURG AREA COMMUNITY COLLEGE AND THE LEBANON COUNTY CAREER AND TECHNOLOGY CENTER, GOOD SAMARITAN HEALTH SYSTEM ASSISTS WITH PROVIDING NURSING STUDENTS THE OPPORTUNITY TO RECEIVE ON-THE-JOB TRAINING WHILE BEING MENTORED AND SUPERVISED BY A NURSING INSTRUCTOR. THE AVAILABILITY OF THESE PROGRAMS WOULD NOT BE POSSIBLE IF IT WERE NOT FOR THE MANY DEDICATED AND HIGHLY SKILLED MEMBERS OF THE EDUCATIONAL SERVICES DEPARTMENT. THESE ARE INDIVIDUALS WHO SEEK PROGRAMS WHICH ARE RELEVANT, TIMELY AND VERY MUCH A NECESSITY IN THE COMMUNITY. IF YOU OR SOMEONE YOU KNOW MAY BENEFIT FROM THE PROGRAMS MENTIONED OR IF YOU WOULD LIKE TO FIND AVAILABILITY FOR ANY OF OUR CLASSES AND SUPPORT GROUPS, PLEASE VISIT OUR WEBSITE AT WWW.GSHLEB.ORG. BELOW IS A LISTING AND BRIEF DESCRIPTION OF PROGRAMS AND SUPPORT GROUPS CURRENTLY OFFERED AT GOOD SAMARITAN: HEALTH EDUCATION -DIABETIC EDUCATION - ASSISTS INDIVIDUALS WITH DIABETES IN CONTROLLING AND COPING WITH THEIR DISEASE (4 CLASSES PER SESSION) -SMOKE STOPPERS - COMPREHENSIVE EDUCATION AND SUPPORT PROGRAM FOR SMOKING CESSATION (8 CLASSES PER SESSION) CPR & FIRST AID TRAINING BABYSITTING COURSE - TRAINING FOR GIRLS AND BOYS 12 YEARS OF AGE AND OVER (3 CLASSES PER SESSION) -HEARTSAVER CPR - BASIC CPR SKILLS FOR ADULT/CHILD AND MANAGEMENT OF CHOKING -HEARTSAVER FIRST AID AND PEDIATRIC FIRST AID - BASIC FIRST AID TRAINING FOR ADULTS AND CHILDREN -BASIC LIFE
MEETING UNMET COMMUNITY NEEDS		THE GOOD SAMARITAN HOSPITAL STRIVES TO FULFILL UNMET COMMUNITY HEALTH NEEDS. AS LEBANON COUNTY'S ONLY HOSPITAL, GOOD SAMARITAN DELIVERS SERVICES THAT CLOSE HEALTHCARE GAPS. THE FOLLOWING PAGES SHOW HOW GOOD SAMARITAN HAS REINVESTED TO MAINTAIN, TO IMPROVE AND TO INCREASE PUBLIC ACCESS TO QUALITY HEALTHCARE SERVICES. HERE ARE SOME EXAMPLES OF HOW GOOD SAMARITAN HAS MADE A DIFFERENCE IN LEBANON COUNTY: WOUND CARE & HYPERBARIC MEDICINE IN 2009 GOOD SAMARITAN OPENED THE FIRST WOUND CARE CENTER IN LEBANON COUNTY TO FULFILL THE UNDERMET NEEDS OF OUR COMMUNITY. CHRONIC OR NON-HEALING WOUNDS CAN RESULT FROM MANY TYPES OF HEALTH CONDITIONS SUCH AS A LACK OF MOBILITY, DIABETES, POOR CIRCULATION, TRAUMA AND VASCULAR DISEASE. THE SPECIALLY TRAINED STAFF AT THE WOUND CARE CENTER INCLUDES A PHYSICIAN, REGISTERED NURSES AND HYPERBARIC THERAPY TECHNICIANS WHO HAVE HAD SPECIALIZED TRAINING IN WOUND CARE. FOR PATIENTS LIKE SCOT ADAMS, THE WOUND CARE CENTER OFFERED HOPE WHEN IT SEEMED AS IF THERE WAS NONE LEFT. SCOT CAME TO US WITH A VERY DEEP INFECTION IN HIS ANKLE CAUSED BY MRSA (METHICILLIN-RESISTANT STAPHYLOCOCCUS AUREUS), POTENTIALLY A VERY VIRULENT AND DIFFICULT TO TREAT BACTERIA, ESPECIALLY IN THE BONE. IT WAS A PERSISTENT INFECTION THAT HAD NOT BEEN ERADICATED BY PREVIOUS TREATMENTS INCLUDING SURGERY AND INTRAVENOUS ANTIBIOTICS. "I WAS LOOKING AT THE POSSIBILITY OF LOSING MY FOOT, EVEN PART OF MY LEG," SAID SCOT. "MY OTHER DOCTORS WERE RUNNING OUT OF OPTIONS. MY WIFE READ AN ARTICLE ABOUT THE WOUND CARE CENTER AND RECOMMENDED THAT I ASK MY DOCTOR IF IT WAS WORTH A TRY. I WAS LUCKY, IT OPENED A FEW WEEKS LATER AND I WAS ONE OF THE FIRST PATIENTS." AFTER FOUR MONTHS AND OVER 60 HYPERBARIC TREATMENTS, SCOT'S WOUND FINALLY HEALED. HE SAID, "IT WAS AMAZING. AFTER EACH TREATMENT YOU COULD SEE AN IMPROVEMENT IN A COUPLE OF DAYS." HE ADDED, "THE EXPERIENCE WAS LIFE-CHANGING AND I AM GRATEFUL FOR THE CARE I RECEIVED FROM THE STAFF. NOT JUST THE MEDICINE, BUT THE WAY THEY TREATED ME AS A PERSON. I FELT LIKE THEY GENUINELY CARED. I WOULD DEFINITELY RECOMMEND THAT PEOPLE WITH A WOUND THAT WON'T HEAL GO TO GOOD SAMARITAN; IT CHANGED MY LIFE." LIFESAVING HYPOTHERMIA TREATMENT: WHEN DALE LONG SUFFERED A SUDDEN CARDIAC ARREST WHILE WORKING AT LEBANON SEABOARD, HIS CO-WORKERS CALLED 911 AND STARTED CPR IMMEDIATELY. ONCE EMTS WERE ON THE SCENE, THEY WERE ABLE TO RESTORE A LIFE SUSTAINING HEART RHYTHM AND TRANSPORT HIM TO THE GOOD SAMARITAN HOSPITAL. STILL UNCONSCIOUS WHEN HE ARRIVED AT THE ER, DOCTORS FOUND THAT DALE HAD SUSTAINED AN INJURY TO HIS HEAD WHEN HE COLLAPSED. FEARING HIS FALL MAY HAVE CAUSED BRAIN DAMAGE, HIS MEDICAL TEAM DECIDED TO IMPLEMENT A PROTOCOL KNOWN AS THERAPEUTIC HYPOTHERMIA, A LIFE-SAVING PROTOCOL OFFERED BY ONLY A FEW HOSPITALS IN THE AREA. THERAPEUTIC HYPOTHERMIA LOWERS THE PATIENT'S BODY TEMPERATURE AND REDUCES THE BRAIN'S DEMAND FOR OXYGEN AND NUTRIENTS RESULTING IN A LOWER RISK OF NEUROLOGICAL IMPAIRMENT. ONCE DALE AWOKE AND SHOWED NO SIGNS OF NEUROLOGICAL IMPAIRMENT, THE TEAM STARTED TO WORK ON HIS HEART TO REPAIR THE VENTRICULAR FIBRILLATION WHICH CAUSED THE SUDDEN ATTACK. DALE RECEIVED A CARDIAC CATHETERIZATION WHERE IT WAS DETERMINED THAT HE SUFFERED FROM FOUR SEVERE BLOCKAGES AND REQUIRED QUADRUPLE BYPASS SURGERY. ALTHOUGH DALE'S BYPASS SURGERY WAS A SUCCESS, HIS HEART MUSCLE WAS WEAKENED LEAVING HIM SUSCEPTIBLE TO HEART RHYTHM ISSUES, KNOWN AS ARRHYTHMIA, WHICH COULD CAUSE FUTURE ATTACKS. DALE WAS FITTED WITH A TEMPORARY EXTERNAL DEFIBRILLATOR CALLED A LIFE VEST. THE LIFE VEST WOULD PAINLESSLY SHOCK HIS HEART BACK INTO A HEALTHY RHYTHM IF IT SUDDENLY WENT INTO A LIFE THREATENING ARRHYTHMIA. AFTER IT WAS DETERMINED HE WAS A CANDIDATE FOR A MORE PERMANENT DEFIBRILLATOR, HE RECEIVED A DEVICE THAT WILL MAINTAIN HIS HEART RHYTHM FOR SEVERAL YEARS AND REQUIRES ONLY AN OUTPATIENT VISIT TO REPLACE IT. FOLLOWING SURGERY DALE WAS ADMITTED TO THE OUTPATIENT CARDIAC REHABILITATION PROGRAM IN ORDER TO SLOWLY REBUILD HIS STAMINA AND DECREASE HIS RISK FOR FUTURE HEART RELATED ILLNESS. AFTER COMPLETING THE PROGRAM IN 18 WEEKS, DALE WAS ABLE TO RETURN TO WORK WITHIN A FEW MONTHS OF SUFFERING A MAJOR CARDIAC EVENT. DALE IS ALIVE TODAY THANKS TO THE QUICK ACTIONS OF HIS CO-WORKERS AND THE ADVANCED CARDIAC CARE HE RECEIVED AT GOOD SAMARITAN. ACCORDING TO DALE, "PERSONAL CARE AND ATTENTION ARE A HUGE PART OF THE HEALING PROCESS AT GOOD SAMARITAN. I ATTRIBUTE THAT TO HOW QUICKLY I RECOVERED." FINDING SPECIALISTS: THE GOOD SAMARITAN HOSPITAL IS ALSO WORKING TO PROTECT THE HEALTH OF LEBANON VALLEY RESIDENTS BY ENSURING THAT THE COUNTY'S PHYSICIAN COMPLEMENT INCLUDES SPECIALISTS NEEDED TO CLOSE GAPS IN THE HEALTHCARE SYSTEM. GOOD SAMARITAN HAS CREATED NEW PRACTICES TO STRENGTHEN PHYSICIAN RECRUITMENT EFFORTS TO ENSURE A LONG-TERM, SUSTAINABLE PHYSICIAN BASE FOR THE COUNTY. THE HOSPITAL ALSO PARTNERS WITH LOCAL PHYSICIANS TO AID IN RECRUITMENT EFFORTS WHEN NECESSARY. ACCESS TO QUALITY HEALTH CARE IMPROVED WHEN GOOD SAMARITAN RECRUITED KEY SPECIALISTS IN RECENT YEARS: GOOD SAMARITAN SURGICAL ASSOCIATES - LEBANON COUNTY HAD LOST A NUMBER OF GENERAL SURGEONS TO RETIREMENT OVER RECENT YEARS. GOOD SAMARITAN CREATED A NEW PRACTICE TO HIRE ONE LOCAL SURGEON AND ADD THREE NEW GENERAL SURGEONS FROM OUTSIDE THE COUNTY. GOOD SAMARITAN GASTROENTEROLOGY ASSOCIATES - THIS PRACTICE HAS STABILIZED THE NUMBER OF GASTROENTEROLOGISTS IN THE COUNTY AND PROVIDES A PLATFORM TO RECRUIT MORE SURGEONS IN THE FUTURE. GOOD SAMARITAN ONCOLOGY & HEMATOLOGY ASSOCIATES - THIS PRACTICE ENABLED THE HOSPITAL TO RECRUIT A NEW ONCOLOGIST TO ACCOMPANY THE TWO TALENTED PROVIDERS ALREADY IN THE COUNTY. GOOD SAMARITAN CARDIOVASCULAR SURGICAL ASSOCIATES - THIS PRACTICE FEATURES THE COUNTY'S ONLY CARDIAC, THORACIC AND VASCULAR SURGEONS. GOOD SAMARITAN PEDIATRICS - THIS PRACTICE IS THE LARGEST PEDIATRIC PRACTICE IN THE COUNTY AND ONE OF THE FEW PRIMARY CARE PROVIDERS ACCEPTING MEDICAID PATIENTS. IN ADDITION, THE HOSPITAL HAS ASSISTED LOCAL PHYSICIANS IN THEIR EFFORTS TO RECRUIT OB/GYN, GASTROENTEROLOGY, CARDIAC AND OTHER KEY SPECIALISTS THAT ARE NEEDED TO ADDRESS THE HEALTH NEEDS OF THE LOCAL POPULATION, BUT WERE NOT AVAILABLE PREVIOUSLY. SAFE NURSES HELP SEXUAL ASSAULT VICTIMS: THE GOOD SAMARITAN HOSPITAL WORKED DILIGENTLY TO IMPROVE THE LIVES OF SEXUAL ASSAULT VICTIMS. OVER THE PAST SEVERAL YEARS, THE HOSPITAL AND ITS NURSES INVESTED THE TIME AND RESOURCES NECESSARY TO CREATE A SEXUAL ASSAULT FORENSIC EXAMINER PROGRAM FOR LEBANON COUNTY - THE FIRST TIME THESE SERVICES HAVE BEEN MADE AVAILABLE WITHIN THE COUNTY. TEN EMERGENCY AND MATERNITY NURSES VOLUNTEERED FOR THE REQUIRED 42.6 HOURS OF TRAINING TO BECOME CERTIFIED AS SAFE NURSES. BY VOLUNTEERING FOR CERTIFICATION, THE MEMBERS OF THE GOOD SAMARITAN HOSPITAL NURSING STAFF WENT ABOVE AND BEYOND THEIR REGULAR DUTIES. THEY NOW ARE ABLE TO EXAMINE THE VICTIMS AND COLLECT FORENSIC EVIDENCE FOR USE BY LAW ENFORCEMENT OFFICIALS IN COURT CASES. IN ADDITION, THE NURSES LEARNED ABOUT HOW TO MAINTAIN THE CHAIN OF EVIDENCE NECESSARY TO PROSECUTE OFFENDERS AND MAY BE ASKED TO SERVE AS EXPERT WITNESSES IN COURT CASES. THE NURSES WERE TRAINED IN HOW TO CONDUCT AN INTERVIEW IN THE BEST POSSIBLE AND MOST THERAPEUTIC WAY, AS WELL AS HOW TO USE THE FORENSIC KIT THAT IS USED DURING THE EXAMINATION OF A SEXUAL ASSAULT VICTIM. THIS HELPS ELIMINATE THE LIKELIHOOD OF MISSED OR IMPROPERLY COLLECTED EVIDENCE AND INCREASES THE NUMBER OF SUCCESSFUL CONVICTIONS OF GUILTY PERPETRATORS DUE TO ADEQUATE PREPARATION FOR COURTROOM TESTIMONY. THE NURSES ARE ALSO TRAINED TO DEAL WITH THE EMOTIONAL TRAUMA OF A SEXUAL ASSAULT VICTIM BY OFFERING A CALMING, COMFORTING AND REASSURING ENVIRONMENT. THE PROGRAM IS INTENDED TO CARE FOR THE WHOLE PERSON, NOT ONLY THE MEDICAL CONDITION, BUT THE EMOTIONAL HEALTH AS WELL. TO ENSURE THAT SEXUAL ASSAULT VICTIMS RECEIVE COORDINATED CARE, THE SAFE NURSES TOOK THE INITIATIVE TO MEET DIRECTLY WITH LOCAL POLICE, THE DISTRICT ATTORNEY'S OFFICE AND THE SEXUAL ASSAULT RESOURCE COUNSELING CENTER. THE FOCUS OF THESE EFFORTS WAS TO ENSURE PROPER COORDINATION TO SUPPORT CRIMINAL PROCEEDINGS AS WELL AS TO PROVIDE A THERAPEUTIC ENVIRONMENT THAT TRANSITIONS INTO A LONG-TERM HEALING PROCESS. THE GOOD SAMARITAN HOSPITAL HAS MADE A FIRM COMMITMENT TO IMPROVING THE QUALITY OF CARE IT PROVIDES TO COUNTY RESIDENTS WHO HAVE BEEN TRAUMATIZED BY SEXUAL ASSAULT. BY PARTNERING WITH LOCAL SEXUAL ASSAULT SUPPORT GROUPS AND LAW ENFORCEMENT, THE GOOD SAMARITAN HOSPITAL IS BETTER ABLE TO HELP PATIENTS MOVE TOWARD RECOVERY AND HEALING. FINDING BREAST CANCER SOONER: DEDICATED TO ADVANCING WOMEN'S HEALTH CARE IN LEBANON COUNTY, GOOD SAMARITAN HEALTH SYSTEM HAS DELIVERED THE LATEST BREAST IMAGING TECHNOLOGY TO OUR COMMUNITY. GOOD SAMARITAN HEALTH SYSTEM NOW PROVIDES ANALOG AND DIGITAL MAMMOGRAPHY, BREAST MRI AND MRI-GUIDED BREAST BIOPSY IN ADDITION TO THE OTHER BREAST-IMAGING SERVICES AVAILABLE THROUGHOUT THE SYSTEM. OUR COMPREHENSIVE BREAST IMAGING SERVICES NOW INCLUDE: DI
AFFILIATED HEALTH CARE SYSTEM	PART VI, LINE 6	THE GOOD SAMARITAN HOSPITAL IS A PART OF THE GOOD SAMARITAN HEALTH SYSTEM. THE SYSTEM INCLUDES A FOUNDATION, DIALYSIS CENTER, REAL ESTATE COMPANIES, MRI CENTER, FAMILY PRACTICES, SPECIALITY HEALTH SERVICES, AND A DME COMPANY. IN ADDITION TO THE COMMUNITY BENEFITS PROVIDED BY THE HOSPITAL, THE HEALTH SYSTEM EVALUATES THE NEEDS THE COMMUNITY AND THE SYSTEM WILL PARTICIPATE IN COMMUNITY BENEFIT PROGRAMS, LIKE SUPPORTING THE VOLUNTEERS IN MEDICINE FREE CLINIC WHICH SERVES THE UNDERPRIVILEGED MEMBERS OF THE COMMUNITY.

Schedule H (Form 990) 2011

Additional Data

Software ID:
Software Version:

- TIN:

Schedule I
(Form 990)

Department of the Treasury
Internal Revenue Service

Grants and Other Assistance to Organizations,
Governments and Individuals in the United States

Complete if the organization answered "Yes," to Form 990, Part IV, line 21 or 22.
lBullet

Attach to Form 990

OMB No. 1545-0047

2011

Open to Public
Inspection

Name of the organization
Good Samaritan Hospital The

Employer identification number
23-0794160

Part I

General Information on Grants and Assistance

Does the organization maintain records to substantiate the amount of the grants or assistance, the grantees' eligibility for the grants or assistance, and
the selection criteria used to award the grants or assistance? ....................................

Yes No

Describe in Part IV the organization's procedures for monitoring the use of grant funds in the United States.

Part II

Grants and Other Assistance to Governments and Organizations in the United States. Complete if the organization answered "Yes" to
Form 990, Part IV, line 21 for any recipient that received more than $5,000. Check this box if no one recipient received more than $5,000. Use
Part IV and Schedule I-1 (Form 990) if additional space is needed ......................... lBullet

(a) Name and address of organization or government	(b) EIN	(c) IRC Code section if applicable	(d) Amount of cash grant	(e) Amount of non-cash assistance	(f) Method of valuation (book, FMV, appraisal, other)	(g) Description of non-cash assistance	(h) Purpose of grant or assistance

Enter total number of section 501(c)(3) and government organizations listed in the line 1 table ................. Bullet Image

Enter total number of other organizations listed in the line 1 table ......................... . Bullet Image

For Privacy Act and Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 50055P

Schedule I (Form 990) 2011

Page 2

Part III

Grants and Other Assistance to Individuals in the United States. Complete if the organization answered "Yes" to Form 990, Part IV, line 22.
Use Schedule I-1 (Form 990) if additional space is needed.

(a)Type of grant or assistance	(b)Number of recipients	(c)Amount of cash grant	(d)Amount of non-cash assistance
(1) DAVID BRODERIC SCHOLARSHIP	21	7,500	0
(2) MARGARET CONNELL SCHOLARSHIP	6	5,000	0
(3) GSH AUXILIARY SCHOLARSHIP	3	2,200	0
(4) CAPLAN NURSING SCHOLARSHIP	4	8,200	0

Part IV

Supplemental Information. Complete this part to provide the information required in Part I, line 2, and any other additional information.

Identifier	Return Reference	Explanation
PROCEDURES TO MONITOR USE OF GRANTS	SCHEDULE I, PART I, LINE 2	THE DAVID BRODERIC EMPLOYEE SCHOLARSHIP PROGRAM AND THE MARGARET L. CONNELL SCHOLARSHIP FUND ARE FOR THE SONS AND DAUGHTERS OF EMPLOYEES. THE GSH AUXILIARY AND CAPLAN NURSING SCHOLARSHIPS ARE AWARDED TO LEBANON COUNTY RESIDENTS ENROLLED IN A NURSING PROGRAM. PART III, COLUMN (B) THE GOOD SAMARITAN HOSPITAL DISTRIBUTES A PORTION OF THE MONEY ALLOTTED TO EVERY PERSON WHO APPLIES FOR THE SCHOLARSHIP.

Schedule I (Form 990) 2011

Additional Data

Software ID:
Software Version:

- TIN:

Schedule J
(Form 990)

Department of the Treasury
Internal Revenue Service

Compensation Information

For certain Officers, Directors, Trustees, Key Employees, and Highest
Compensated Employees
SchJMediumBullet

Complete if the organization answered "Yes" to Form 990,
Part IV, question 23.
SchJMediumBullet

Attach to Form 990. SchJMediumBullet

See separate instructions.

OMB No. 1545-0047

2011

Open to Public Inspection

Name of the organization

Good Samaritan Hospital The

Employer identification number

23-0794160

Part I

Questions Regarding Compensation

Yes

Check the appropiate box(es) if the organization provided any of the following to or for a person listed in Form
990, Part VII, Section A, line 1a. Complete Part III to provide any relevant information regarding these items.

First-class or charter travel Housing allowance or residence for personal use

Travel for companions Payments for business use of personal residence

Tax idemnification and gross-up payments Health or social club dues or initiation fees

Discretionary spending account Personal services (e.g., maid, chauffeur, chef)

If any of the boxes in line 1a are checked, did the organization follow a written policy regarding payment or reimbursement or provision of all the expenses described above? If "No," complete Part III to explain....

Did the organization require substantiation prior to reimbursing or allowing expenses incurred by all
officers, directors, trustees, and the CEO/Executive Director, regarding the items checked in line 1a? ....

Indicate which, if any, of the following the organization uses to establish the compensation of the
organization's CEO/Executive Director. Check all that apply. Do not check any boxes for methods
used by a related organization to establish compensation of the CEO/Executive Director, but explain in Part III.

Compensation committee Written employment contract

Independent compensation consultant Compensation survey or study

Form 990 of other organizations Approval by the board or compensation committee

During the year, did any person listed in Form 990, Part VII, Section A, line 1a with respect to the filing organization or a related organization:

Receive a severance payment or change-of-control payment? ...............

Participate in, or receive payment from, a supplemental nonqualified retirement plan? ........

Yes

Participate in, or receive payment from, an equity-based compensation arrangement? ........

If "Yes" to any of lines 4a-c, list the persons and provide the applicable amounts for each item in Part III.

Only 501(c)(3) and 501(c)(4) organizations only must complete lines 5-9.

For persons listed in form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the revenues of:

The organization? ...........................

Any related organization? .........................

If "Yes," to line 5a or 5b, describe in Part III.

For persons listed in form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the net earnings of:

The organization? ...........................

Any related organization? .........................

If "Yes," to line 6a or 6b, describe in Part III.

For persons listed in Form 990, Part VII, Section A, line 1a, did the organization provide any non-fixed
payments not described in lines 5 and 6? If "Yes," describe in Part III ............

Yes

Were any amounts reported in Form 990, Part VII, paid or accured pursuant to a contract that was
subject to the initial contract exception described in Regulations section 53.4958-4(a)(3)? If "Yes," describe
in Part III .............................

If "Yes" to line 8, did the organization also follow the rebuttable presumption procedure described in Regulations section 53.4958-6(c)? .........................

For Privacy Act and Paperwork Reduction Act Notice, see the Intructions for Form 990

Cat. No. 50053T

Schedule J (Form 990) 2011

Page 2

Part II

Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees. Use duplicate copies if additional space is needed.

For each individual whose compensation must be reported in Schedule J, report compensation from the organization on row (i) and from related organizations, described in the
instructions on row (ii). Do not list any individuals that are not listed on Form 990, Part VII.

Note. The sum of columns (B)(i)-(iii) for each listed individual must equal the total amount of Form 990, Part VII, Section A, line 1a, applicable column (D) and column (E) for that individual.

(A) Name		(B) Breakdown of W-2 and/or 1099-MISC compensation			(C) Retirement and other deferred compensation	(D) Nontaxable benefits	(E) Total of columns (B)(i)-(D)	(F) Compensation reported as deferred in prior Form 990
(A) Name		(i) Base compensation	(ii) Bonus & incentive compensation	(iii) Other reportable compensation	(C) Retirement and other deferred compensation	(D) Nontaxable benefits	(E) Total of columns (B)(i)-(D)	(F) Compensation reported as deferred in prior Form 990
(1) ROBERT J LONGO	(i) (ii)	407,197 0	85,050 0	21,262 0	0 0	796 0	514,305 0	0 0
(2) KIMBERLY FEEMAN	(i) (ii)	232,644 0	37,180 0	15,414 0	0 0	0 0	285,238 0	0 0
(3) JACQUELYN M GOULD	(i) (ii)	159,373 0	27,287 0	9,558 0	0 0	0 0	196,218 0	0 0
(4) ROBERT J RICHARDS	(i) (ii)	234,109 0	38,744 0	19,126 0	0 0	0 0	291,979 0	0 0
(5) JULIE MIKSIT	(i) (ii)	138,408 0	23,250 0	12,035 0	0 0	0 0	173,693 0	0 0
(6) ROBERT D SHAVER MD	(i) (ii)	292,136 0	43,540 0	0 0	0 0	0 0	335,676 0	0 0
(7) ELIZABETH MUHIIRE-NTAKI	(i) (ii)	153,213 0	15,768 0	0 0	0 0	0 0	168,981 0	0 0
(8) DARIA KOVARIKOVA	(i) (ii)	179,441 0	8,239 0	0 0	0 0	0 0	187,680 0	0 0
(9) BYARD YODER	(i) (ii)	165,197 0	0 0	8,518 0	0 0	0 0	173,715 0	0 0
(10) ROBERTA SCHERR	(i) (ii)	169,280 0	0 0	0 0	0 0	0 0	169,280 0	0 0
(11) RICHARD FOLLETT	(i) (ii)	147,952 0	5,000 0	12,063 0	0 0	0 0	165,015 0	0 0

Schedule J (Form 990) 2011

Page 3

Part III

Supplemental Information

Complete this part to provide the information, explanation, or descriptions required for Part I, lines 1a, 1b, 3, 4c, 5a, 5b, 6a, 6b, 7, and 8. Also complete this part for any additional information.

Identifier	Return Reference	Explanation
SUPPLEMENTAL COMPENSATION INFORMATION	PART I, LINE 3	THE COMPENSATION COMMITTEE HIRES AN INDEPENDENT COMPENSATION CONSULTANT TO ESTABLISH THE CEO'S COMPENSATION AMOUNT AND COMPOSE THE CONTRACT. THE COMPENSATION COMMITTEE PRESENTS THE INFORMATION TO THE BOARD. IF A BOARD MEMBER WOULD LIKE TO REVIEW THE CONTRACT, THEY CAN CONTACT A MEMBER OF THE COMPENSATION COMMITTEE TO REVIEW THE CONTRACT PRIVATELY. PART I, LINE 4B ROBERT J. LONGO IS A PARTICIPANT IN A 457F RETIREMENT PLAN. HE RECEIVED NO PAYMENT FROM THE PLAN THIS YEAR. PART I, LINE 7 THE EXECUTIVE BONUS PROGRAM IS A NON-FIXED PAYMENT PROGRAM. DISCRETION IS EXERCISED AS TO THE AMOUNT AND WHEN/IF PAYMENT WILL BE MADE.

Schedule J (Form 990) 2011

Additional Data

Software ID:
Software Version:

- TIN:

Schedule K
(Form 990)

Department of the Treasury
Internal Revenue Service

Supplemental Information on Tax Exempt Bonds

Complete if the organization answered "Yes" to Form 990, Part IV, line 24a. Provide descriptions,
explanations, and any additional information in Part VI.
SchKMediumBullet

Attach to Form 990. SchKMediumBullet

See separate instructions.

OMB No. 1545-0047

2011

Open to Public
Inspection

Name of the organization
Good Samaritan Hospital The

Employer identification number
23-0794160

Part I

Bond Issues

(a) Issuer Name		(b) Issuer EIN	(c) CUSIP #	(d) Date Issued	(e) Issue Price	(f) Description of Purpose	(g) Defeased		(h) On Behalf of Issuer		(i) Pool financing
(a) Issuer Name		(b) Issuer EIN	(c) CUSIP #	(d) Date Issued	(e) Issue Price	(f) Description of Purpose	Yes	No	Yes	No	Yes	No
A	LEBANON COUNTY HEALTH FACILITIES AUTHORITY	23-2546819	522455BE3	03-11-2004	17,255,816	SEE PART VI		X		X		X

Part II

Proceeds

	A		B		C		D
	1 Amount of bonds retired . . . . . . . . . . . . .	0
2 Amount of bonds legally defeased . . . . . . . . . .	0
3 Total proceeds of issue . . . . . . . . . . . . .	17,255,816
4 Gross proceeds in reserve funds . . . . . . . .	0
5 Capitalized interest from proceeds . . . . . . . . . .	0
6 Proceeds in refunding escrows . . . . . . . . . . .	0
7 Issuance costs from proceeds . . . . . . . . . . .	0
8 Credit enhancement from proceeds . . . . . . . . . .	0
9 Working capital expenditures from proceeds . . . . . . .	0
10 Capital expenditures from proceeds . . . . . . . . . .	0
11 Other spent proceeds . . . . . . . . . . .	0
12 Other unspent proceeds . . . . . . . . . . .	0
13 Year of substantial completion . . . . . . . . . . .	2004
	Yes	No	Yes	No	Yes	No	Yes	No
14 Were the bonds issued as part of a current refunding issue? . . . .	X
15 Were the bonds issued as part of an advance refunding issue? . . . .		X
16 Has the final allocation of proceeds been made? . . . . . .	X
17 Does the organization maintain adequate books and records to support the final allocation of proceeds? . . . . . . . . . . . . .	X

Part III

Private Business Use

	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
1 Was the organization a partner in a partnership, or a member of an LLC, which owned property financed by tax-exempt bonds? . . . . . . .
2 Are there any lease arrangements that may result in private business use of bond-financed property? . . . . . . . . .

For Privacy Act and Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 50193E

Schedule K (Form 990) 2011

Page 2

Part III

Private Business Use (Continued)

	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
3a Are there any management or service contracts that may result in private business use of bond-financed property? . . . . . . . . .
b If ‘Yes’ to line 3a, does the organization routinely engage bond counsel or other outside counsel to review any management or service contracts relating to the financed property? . . . . .
c Are there any research agreements that may result in private business use of bond-financed property? . . . . . . .
d If ‘Yes’ to line 3c, does the organization routinely engage bond counsel or other outside counsel to review any research agreements relating to the financed property? .
4 Enter the percentage of financed property used in a private business use by entities other than a section 501(c)(3) organization or a state or local government . .	0%		%		%		%
5 Enter the percentage of financed property used in a private business use as a result of unrelated trade or business activity carried on by your organization, another section 501(c)(3) organization, or a state or local government . . . . . . .	%		%		%		%
6 Total of lines 4 and 5 . . .. . . . . . . . .	%		%		%		%
7 Does the bond issue meet the private security or payment test? . . .
8 Has the organization established written procedures to ensure that all nonqualified bonds of the issue are remediated in accordance with the requirements under Regulations sections 1.141-12 and 1.145-2?

Part IV

Arbitrage

	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
1 Has a Form 8038-T, Arbitrage Rebate, Yield Reduction and Penalty in Lieu of Arbitrage Rebate, been filed with respect to the bond issue? . . .		X
2 Is the bond issue a variable rate issue?		X
3a Has the organization or the governmental issuer entered into a qualified hedge with respect to the bond issue?		X
b Name of provider . . . . . . . .	0
c Term of hedge . . . . . . . .
d Was the hedge superintegrated? . . . .
e Was a hedge terminated? . . . . .
4a Were gross proceeds invested in a guaranteed investment contract (GIC)? . . . . . .		X
b Name of provider . . . . . .	0
c Term of GIC . . . . . . .
d Was the regulatory safe harbor for establishing the fair market value of the GIC satisfied? . . . . . .
5 Were any gross proceeds invested beyond an available temporary period? . . . . . .		X
6 Did the bond issue qualify for an exception to rebate? .	X
7 Has the organization established written procedures to monitor the requirements of section 148? . . .	X

Schedule K (Form 990) 2011

Page 3

Part V

Procedures To Undertake Corrective Action

Has the organization established written procedures to ensure that violations of federal tax requirements are timely identified and corrected through the voluntary closing agreement program if self-remediation is not available under applicable regulations? . . . . . . . . . . . . . . YesNo

Part VI

Supplemental Information

Complete this part to provide additional information for responses to questions on Schedule K (see instructions).

Identifier	Return Reference	Explanation
SCHEDULE K	0	REFUND OUTSTANDING 94 BONDS ISSUED ON 1/13/94

Schedule K (Form 990) 2011

Additional Data

Software ID:
Software Version:

- TIN:

Schedule L
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service

Transactions with Interested Persons

Complete if the organization answered
"Yes" on Form 990, Part IV, lines 25a, 25b, 26, 27, 28a, 28b, or 28c,
or Form 990-EZ, Part V lines 38a or 40b.
MediumBullet

Attach to Form 990 or Form 990-EZ. MediumBullet

See separate instructions.

OMB No. 1545-0047

2011

Open to Public Inspection

Name of the organization

Good Samaritan Hospital The

Employer identification number

23-0794160

Part I

Excess Benefit Transactions (section 501(c)(3) and section 501 (c)(4) organizations only).
Complete if the organization answered "Yes" on Form 990, Part IV, line 25a or 25b, or Form 990-EZ, Part V, line 40b.

1(a) Name of disqualified person	(b) Description of transaction	(c) Corrected?
1(a) Name of disqualified person	(b) Description of transaction	Yes	No

Enter the amount of tax imposed on the organization managers or disqualified persons during the year under section 4958. ......................... Bullet Image

Enter the amount of tax, if any, on line 2, above, reimbursed by the organization ....... Bullet Image

Part II

Loans to and/or From Interested Persons.
Complete if the organization answered "Yes" on Form 990, Part IV, line 26, or Form 990-EZ, Part V, line 38a.

(a) Name of interested person and purpose	(b) Loan to or from the organization?		(c)Original principal amount	(d)Balance due	(e) In default?		(f) Approved by board or committee?		(g)Written agreement?
(a) Name of interested person and purpose	To	From	(c)Original principal amount	(d)Balance due	Yes	No	Yes	No	Yes	No






Total ............... $

Part III

Grants or Assistance Benefitting Interested Persons.
Complete if the organization answered "Yes" on Form 990, Part IV, line 27.

(a) Name of interested person	(b)Relationship between interested person and the organization	(c)Amount of grant or type of assistance

For Privacy Act and Paperwork Reduction Act Notice, see the
Instructions for Form 990 or 990-EZ.

Cat. No. 50056A

Schedule L (Form 990 or 990-EZ) 2011

Page 2

Part IV

Business Transactions Involving Interested Persons.
Complete if the organization answered "Yes" on Form 990, Part IV, line 28a, 28b, or 28c.

(a) Name of interested person	(b) Relationship between interested person and the organization	(c) Amount of transaction	(d) Description of transaction	(e) Sharing of organization's revenues?
(a) Name of interested person		(c) Amount of transaction	(d) Description of transaction	Yes	No
(1) ARTHUR FUNK AND SONS	SEE PART V	365,370	CONSTRUCTION PROJECTS		No
(2) WELCH WAGNER PARTNERSHIP	SEE PART V	280,071	PROPERTY RENTAL		No
(3) FREDERICK CHEVROLET CADILLAC TOYO	SEE PART V	111,382	CAR SALES		No
(4) REILLYWOLFSONSHEFFEYSCHRUMLUNDB	SEE PART V	108,857	ATTORNEY FEES		No

Part V

Supplemental Information

Complete this part to provide additional information for responses to questions on Schedule L (see instructions).

Identifier	Return Reference	Explanation
SCHEDULE L		PART IV, LINE 1 ROBERT J. FUNK, A TRUSTEE OF THE GOOD SAMARITAN HOSPITAL, IS A PARTNER IN ARTHUR FUNK AND SONS. PART IV, LINE 2 JOHN WELCH, A TRUSTEE OF THE GOOD SAMARITAN HOSPITAL, IS A PARTNER IN WELCH WAGNER PARTNERSHIP. PART IV, LINE 3 FREDERICK LAURENZO, A TRUSTEE OF THE GOOD SAMARITAN HOSPITAL, IS A PARTNER IN FREDERICK CHEVROLET, CADILLAC, AND TOYOTA. PART IV, LINE 4 FREDERICK WOLFSON, A TRUSTEE OF THE GOOD SAMARITAN HOSPITAL, IS A PARTNER IN REILLY, WOLFSON, SHEFFEY, SCHRUM & LUNDBERG.

Schedule L (Form 990 or 990-EZ) 2011

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE O
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service

Supplemental Information to Form 990 or 990-EZ

Complete to provide information for responses to specific questions on
Form 990 or to provide any additional information.
MediumBullet

Attach to Form 990 or 990-EZ.

OMB No. 1545-0047

2011

Open to Public
Inspection

Name of the organization

Good Samaritan Hospital The

Employer identification number

23-0794160

Identifier	Return Reference	Explanation
EXPLANATION FOR CHANGES TO PRIOR YEAR REVENUE AMOUNTS FROM 2010 RETURN	FORM 990, PART I, LINES 9 AND 11	During the audit for the year ending 6/30/2012, the auditors determined that the money received from the state of Pennsylvania for the Medicaid Modernization Act should be considered program service revenue rather than other revenue. As a result of this determination, the auditors restated the program service and other revenue for 6/30/2011. On Part I of the 2011 990, the revenue listed on lines 9 and 11 for the prior year will not match the 2010 990 revenue numbers due to the revised audited financial statements. PART III, LINE 4A - PROGRAM SERVICE EXPENSE #1 THE GSH IS A 196 LICENSED BED, (ACUTE CARE 177, SKILLED CARE 19) TAX EXEMPT, NON-PROFIT ACUTE CARE HOSPITAL PROVIDING A FULL RANGE OF INPATIENT AND OUTPATIENT SERVICES INCLUDING RESPIRATORY THERAPY, PHYSICAL THERAPY, RADIOLOGY, INPATIENT AND OUTPATIENT SURGERY, PEDIATRICS, INTENSIVE CARE, TELEMETRY, CARDIAC CARE, HEMODIALYSIS, INHALATION THERAPY, PULMONARY FUNCTIONS, ENDOSCOPY, 24 HOUR EMERGENCY CARE, OCCUPATIONAL MEDICINE, TRACTION, PACEMAKERS, EEG, EKG, STRESS MONITORING, MAMMOGRAPHY, ULTRASOUND, CT SCAN, CANCER CARE, NUCLEAR MEDICINE, PHARMACY, OBSTETRICS, BLOOD BANK, PERIPHERAL VASCULAR LAB, CARDIOVASCULAR LAB, CARDIOVASCULAR SURGERY, AND LABORATORY WHICH INCLUDE CHEMISTRY, HEMATOLOGY, HISTOLOGY, CYTOLOGY AND MICROBIOLOGY. FY 6/30/12 STATISTICS: 7,402 ADMISSIONS, 32,552 INPATIENT DAYS; 283,650 OUTPATIENT REGISTRATIONS. PART III, LINE 4D - PROGRAM SERVICE EXPENSE #4 THE GSH OPERATES HOME HEALTH/VISITING NURSE ASSOCIATION PROVIDING A FULL RANGE OF IN-HOME HEALTH CARE INCLUDING IV THERAPY, MATERNAL/INFANT CARE, HOSPICE, PHYSICAL THERAPY, SPEECH THERAPY, OCCUPATIONAL THERAPY, NUTRITIONAL THERAPY, SOCIAL SERVICES AND HOME HEALTH AIDES. FY 6/30/12 STATISTICS: 15,904 IN-HOME CARE VISITS WERE PROVIDED.
COMMITTEES WITH BROAD AUTHORITY	FORM 990, PART VI, LINE 1A	THERE ARE NO MATERIAL DIFFERENCES IN VOTING RIGHTS AMONG THE MEMBERS OF THE GOVERNING BODY. THE EXECUTIVE COMMITTEE SHALL CONSIST OF THE OFFICERS OF THE CORPORATION OTHER THAN THE VICE PRESIDENTS, THE PRESIDENT OF THE MEDICAL STAFF, THE SOLICITOR, THE CHAIRMEN OF ALL STANDING COMMITTEES AND THE MOST RECENT PAST CHAIRMAN OF THE BOARD. IT SHALL BE THE DUTY OF THE EXECUTIVE COMMITTEE TO REVIEW MATTERS BROUGHT TO ITS ATTENTION AND TO MAKE RECOMMENDATIONS TO THE BOARD FOR BOARD ACTION. IT SHALL HAVE THE POWER TO TRANSACT EMERGENCY BUSINESS OF THE CORPORATION DURING THE INTERVAL BETWEEN BOARD MEETINGS, PROVIDED SUCH ACTION DOES NOT CONFLICT WITH POLICIES AND EXPRESSED WISHES OF THE BOARD. IT SHALL REPORT ANY ACTIONS TAKEN TO THE BOARD AT THE BOARD'S NEXT REGULAR MEETING. MEMBERS OR STOCKHOLDERS FORM 990, PART VI, LINE 6 THE GOOD SAMARITAN HEALTH SERVICES FOUNDATION, ANOTHER 501(C)(3) ORGANIZATION, IS THE SOLE MEMBER OF THE GOOD SAMARITAN HOSPITAL.
MEMBERS WHO MAY ELECT TRUSTEES OF THE GOVERNING BODY	FORM 990, PART VI, LINE 7A	THE GOOD SAMARITAN HEALTH SERVICES FOUNDATION, AS THE SOLE MEMBER OF THE GOOD SAMARITAN HOSPITAL, MAY ELECT ONE OR MORE TRUSTEES OF THE HOSPITAL'S GOVERNING BODY. DECISION OF GOVERNING BODY SUBJECT TO APPROVAL BY MEMBERS FORM 990, PART VI, LINE 7B CERTAIN DECISIONS OF THE HOSPITAL'S GOVERNING BODY ARE SUBJECT TO APPROVAL BY THE HOSPITAL'S SOLE MEMBER, THE GOOD SAMARITAN HEALTH SERVICES FOUNDATION.
REVIEW PROCESS OF FORM 990	FORM 990, PART VI, LINE 11B	AN ACCOUNTANT PREPARES THE 990 AND 990-T FOR THE GOOD SAMARITAN HOSPITAL. THE HOSPITAL THEN PAYS AN AUDITING FIRM TO REVIEW THE 990 TAX RETURN. THE CONTROLLER AND THE CFO REVIEW THE FINAL DRAFT OF THE RETURN BEFORE IT IS DISTRIBUTED TO THE BOARD OF DIRECTORS AND THEN FILED WITH THE IRS.
MONITORING & ENFORCEMENT OF CONFLICT OF INTEREST POLICY	FORM 990, PART VI, LINE 12C	THE GOOD SAMARITAN HOSPITAL HAS A COMPLIANCE OFFICER THAT IS RESPONSIBLE FOR MONITORING AND ENFORCING THE COMPLIANCE OF POLICIES. THE BOARD MEMBERS SIGN A CONFLICT OF INTEREST STATEMENT EVERY YEAR WHICH STATES WHAT ORGANIZATIONS OR BUSINESSES HE OR SHE IS THE OWNER, OFFICER, MEMBER OR EMPLOYEE. IF AN ISSUE IS BROUGHT TO THE BOARD AND THERE IS A CONFLICT OF INTEREST THAT INVOLVES ONE OF THE BOARD MEMBERS THAT BOARD MEMBER WOULD REMOVE HIMSELF OR HERSELF FROM THE DISCUSSION AND ABSTAIN FROM VOTING ON THE ISSUE. DETERMINATION OF COMPENSATION FORM 990, PART VI, LINE 15A THE COMPENSATION COMMITTEE HIRES AN INDEPENDENT COMPENSATION CONSULTANT TO ESTABLISH THE CEO'S COMPENSATION AND COMPOSE THE CONTRACT. THE COMPENSATION COMMITTEE PRESENTS THE INFORMATION TO THE BOARD FOR DISCUSSION. THE DELIBERATION AND COMPENSATION DECISION ARE DOCUMENTED IN THE COMMITTEE AND/OR BOARD MINUTES.
DISCLOSURE OF DOCUMENTS TO THE PUBLIC	FORM 990, PART VI, LINE 19	THE GOOD SAMARITAN HOSPITAL HAS ALL OF ITS POLICIES AND FINANCIAL STATEMENTS AVAILABLE FOR THE GENERAL PUBLIC. THE PUBLIC NEEDS TO SCHEDULE AN APPOINTMENT WITH ADMINISTRATION TO COME IN AND VIEW THE INFORMATION UNDER HOSPITAL SUPERVISION.
AVERAGE HOURS PER WEEK DEVOTED TO RELATED ORGANIZATIONS	FORM 990, PART VII, SECTION A, COLUMN (B)	ALL OF THE HOSPITAL TRUSTEES ALSO SERVE 1 HOUR PER WEEK ON THE GOOD SAMARITAN HEALTH SERVICE FOUNDATION'S BOARD. ROBERT J. LONGO GOOD SAMARITAN HOSPITAL - 40 HOURS/WEEK GOOD SAMARITAN HEALTH SERVICES FOUNDATION - 1 HOUR/WEEK GOOD SAMARITAN PHYSICIAN SERVICES - 12 HOURS/WEEK GSH SERVICES, INC. - 1 HOUR/WEEK GOOD SAMARITAN REAL ESTATE, INC. - 1 HOUR/WEEK GSH REALTY, INC. - 1 HOUR/WEEK GSH HOME MED CARE, INC. - 1 HOUR/WEEK GSH DIALYSIS, INC. - 1 HOUR/WEEK LEBANON MRI ASSOCIATES, LTD. - 1 HOUR/WEEK GOOD SAMARITAN PHYSICIAN HOSPITAL ORGANIZATION - 1 HOUR/WEEK ROBERT J. RICHARDS GOOD SAMARITAN HOSPITAL - 40 HOURS/WEEK GOOD SAMARITAN PHYSICIAN SERVICES - 12 HOURS/WEEK GSH SERVICES, INC. - 1 HOUR/WEEK GOOD SAMARITAN REAL ESTATE, INC. - 1 HOUR/WEEK GSH REALTY, INC. - 1 HOUR/WEEK GSH HOME MED CARE, INC. - 1 HOUR/WEEK GSH DIALYSIS, INC. - 1 HOUR/WEEK LEBANON MRI ASSOCIATES, LTC. - 1 HOUR/WEEK GOOD SAMARITAN PHYSICIAN HOSPITAL ORGANIZATION - 1 HOUR/WEEK KIMBERLY FEEMAN GOOD SAMARITAN HOSPITAL - 40 HOURS/WEEK GOOD SAMARITAN PHYSICIAN SERVICES - 12 HOURS/WEEK LEBANON MRI ASSOCIATES, LTC. - 3 HOURS/WEEK JACQUELYN M. GOULD GOOD SAMARITAN HOSPITAL - 40 HOURS/WEEK GOOD SAMARITAN PHYSICIAN SERVICES - 12 HOURS/WEEK GSH DIALYSIS, INC. - 3 HOURS/WEEK JULIE MIKSIT GOOD SAMARITAN HOSPITAL - 40 HOURS/WEEK GOOD SAAMRITAN PHYSICIAN SERVICES - 10 HOURS/WEEK ROBERT D. SHAVER, M.D. GOOD SAMARITAN HOSPITAL - 40 HOURS/WEEK GOOD SAMARITAN PHYSICIAN SERVICES - 10 HOURS/WEEK
OTHER CHANGES IN NET ASSETS OR FUND BALANCE	FORM 990, PART XI, LINE 5	THE GOOD SAMARITAN HOSPITAL NEEDED TO RESERVE MONEY IN ORDER TO PROVIDE THE RETIRED EMPLOYEES AND FUTURE RETIRED EMPLOYEES WITH SUFFICIENT PENSION PAYMENTS. THE GOOD SAMARITAN HOSPITAL WAS ABLE TO RELEASE FUNDS THAT WERE RESTRICTED FOR A SPECIFIC PURPOSE. THE GOOD SAMARITAN HOSPITAL WROTE OFF A LARGE RECEIVABLE THAT WAS DUE FROM THE AFFILIATED CORPORATION GOOD SAMARITAN PHYSICIAN SERVICES. THE HOSPITAL ALSO HAD UNREALIZED LOSSES FROM ITS INVESTMENT PORTFOLIO. UNREALIZED LOSS ON INVESTMENTS $ (265,224) PENSION RESERVE ADJUSTMENT (27,651,540) GOOD SAMARITAN PHY SVCS REC WRITE-OFF (8,748,175) ----------- $(36,664,939) ============= **NOTE: GOOD SAMARITAN PHYSICIAN SERVICES IS A RELATED 501(C)(3) EXEMPT ORGANIZATION.

For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.

Cat. No. 51056K

Schedule O (Form 990 or 990-EZ) 2011

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE R
(Form 990)

Department of the Treasury
Internal Revenue Service

Related Organizations and Unrelated Partnerships

Complete if the organization answered "Yes" to Form 990, Part IV, line 33, 34, 35, 36, or 37.
MediumBullet

Attach to Form 990. MediumBullet

See separate instructions.

OMB No. 1545-0047

2011

Open to Public Inspection

Name of the organization

Good Samaritan Hospital The

Employer identification number

23-0794160

Part I

Identification of Disregarded Entities (Complete if the organization answered "Yes" on Form 990, Part IV, line 33.)

(a) Name, address, and EIN of disregarded entity	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Total income	(e) End-of-year assets	(f) Direct controlling entity

Part II

Identification of Related Tax-Exempt Organizations (Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related tax-exempt organizations during the tax year.)

(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Exempt Code section	(e) Public charity status (if section 501(c)(3))	(f) Direct controlling entity	(g) Section 512(b)(13) controlled organization
(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Exempt Code section	(e) Public charity status (if section 501(c)(3))	(f) Direct controlling entity	Yes	No
(1) GOOD SAMARITAN HEALTH SERVICE FOUNDATION 259 SOUTH FOURTH STREET LEBANON,PA17042 23-2356151	PARENT	PA	501(C)(3)	11,TYPE I	NA		No
(2) GOOD SAMARITAN REAL ESTATE 241 SOUTH FOURTH STREET LEBANON,PA17042 23-2447262	TITLE HOLDING	PA	501(C)(2)		GSHS FDN	Yes
(3) GSH DIALYSIS INC 440 OAK STREET LEBANON,PA17042 23-2500940	DIALYSIS SVCS	PA	501(C)(3)	3	GSHS FDN	Yes
(4) GOOD SAMARITAN PHYSICIAN SERVICES 259 SOUTH FOURTH STREET LEBANON,PA17042 23-1832359	FAMILY MED	PA	501(C)(3)	9	GSHS FDN	Yes

For Privacy Act and Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 50135Y

Schedule R (Form 990) 2011

Page 2

Part III

Identification of Related Organizations Taxable as a Partnership (Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related organizations treated as a partnership during the tax year.)

(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(f) Share of total income	(g) Share of end-of-year assets	(h) Disproprtionate allocations?		(i) Code VUBI amount in box 20 of Schedule K-1 (Form 1065)	(j) General or managing partner?
(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(f) Share of total income	(g) Share of end-of-year assets	Yes	No	(i) Code VUBI amount in box 20 of Schedule K-1 (Form 1065)	Yes	No
(1) LEBANON MRI ASSOCIATES LTD 4THWALNUT ST LEBANON,PA17042 36-3730905	MRI SERVICES	PA	NA

Part IV

Identification of Related Organizations Taxable as a Corporation or Trust (Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related organizations treated as a corporation or trust during the tax year.)

(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(e) Type of entity (C corp, S corp, or trust)
(1) GSH SERVICES INC 241 SOUTH FOURTH STREET LEBANON,PA17042 23-2353047	MGMT & ACCTG	PA	GSHS FOUNDATION	C CORP
(2) GSH HOME MED CARE INC 301 SCHNEIDER DRIVE LEBANON,PA17046 23-2028099	MEDICAL EQUIP	PA	GSHS FOUNDATION	C CORP
(3) GSH REALTY INC 241 SOUTH FOURTH STREET LEBANON,PA17042 23-2446622	TITLE HOLDING	PA	GSHS FOUNDATION	C CORP

Schedule R (Form 990) 2011

Page 3

Part V

Transactions With Related Organizations (Complete if the organization answered "Yes" on Form 990, Part IV, line 34, 35, 35A, or 36.)

Note. Complete line 1 if any entity is listed in Parts II, III or IV.

Yes

1 During the tax year, did the orgranization engage in any of the following transactions with one or more related organizations listed in Parts II-IV?

a Receipt of (i) interest (ii) annuities (iii) royalties (iv) rent from a controlled entity . . . . . . . . . . . . . . . . . . . . . . .

b Gift, grant, or capital contribution to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

c Gift, grant, or capital contribution from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

d Loans or loan guarantees to or for related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

e Loans or loan guarantees by related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

f Sale of assets to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

g Purchase of assets from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

h Exchange of assets with related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

i Lease of facilities, equipment, or other assets to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes

j Lease of facilities, equipment, or other assets from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes

k Performance of services or membership or fundraising solicitations for related organization(s) . . . . . . . . . . . . . . . . . . . .

Yes

l Performance of services or membership or fundraising solicitations by related organization(s) . . . . . . . . . . . . . . . . . . . .

Yes

m Sharing of facilities, equipment, mailing lists, or other assets with related organization(s) . . . . . . . . . . . . . . . . . . . . .

n Sharing of paid employees with related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

o Reimbursement paid to related organization(s) for expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

p Reimbursement paid by related organization(s) for expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes

q Other transfer of cash or property to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

r Other transfer of cash or property from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

If the answer to any of the above is "Yes," see the instructions for information on who must complete this line, including covered relationships and transaction thresholds.

(a) Name of other organization	(b) Transaction type(a-r)	(c) Amount involved	(d) Method of determining amount involved
(1) GOOD SAMARITAN REAL ESTATE INC	J	605,522	LEASE AGREEMENT
(2) GSH REALTY INC	J	312,966	LEASE AGREEMENT
(3) LEBANON MRI ASSOCIATES LTD	L	486,123	MEDICARE REIMB
(4) GSH HOME MED CARE INC	L	105,982	CASH
(5) GSH HOME MED CARE INC	P	94,236	FMV
(6) GSH HOME MED CARE INC	P	59,645	SALARIES
(7) GSH DIALYSIS INC	K	145,379	MEDICARE REIMB
(8) GSH DIALYSIS INC	P	286,617	CASH
(9) GSH DIALYSIS INC	P	51,708	SALARIES
(10) GOOD SAMARITAN PHYSICIAN SERVICES	P	473,190	INSURANCE
(11) GOOD SAMARITAN PHYSICIAN SERVICES	P	96,264	FMV
(12) GOOD SAMARITAN PHYSICIAN SERVICES	P	498,658	SALARIES
(13) GOOD SAMARITAN PHYSICIAN SERVICES	I	229,254	LEASE AGREEMENT
(14) LEBANON MRI ASSOCIATES LTD	I	125,653	LEASE AGREEMENT

Schedule R (Form 990) 2011

Page 4

Part VI

Unrelated Organizations Taxable as a Partnership (Complete if the organization answered "Yes" on Form 990, Part IV, line 37.)

Provide the following information for each entity taxed as a partnership through which the organization conducted more than five percent of its activities (measured by total assets or gross revenue) that was not a related organization. See instructions regarding exclusion for certain investment partnerships.

(a) Name, address, and EIN of entity	(b) Primary activity	(c) Legal domicile (state or foreign country)	(e) Are all partners section 501(c)(3) organizations?		(f) Share of total income	(g) Share of end-of-year assets	(h) Disproprtionate allocations?		(i) Code VUBI amount in box 20 of Schedule K-1 (Form 1065)	(j) General or managing partner?
(a) Name, address, and EIN of entity	(b) Primary activity	(c) Legal domicile (state or foreign country)	Yes	No	(f) Share of total income	(g) Share of end-of-year assets	Yes	No	(i) Code VUBI amount in box 20 of Schedule K-1 (Form 1065)	Yes	No

Schedule R (Form 990) 2011

Page 5

Part VII

Supplemental Information

Complete this part to provide additional information for responses to questions on Schedule R (see instructions).

Identifier	Return Reference	Explanation

Additional Data

Software ID:
Software Version:

1	Briefly describe the organization’s mission or most significant activities: TO PROVIDE HIGH-QUALITY, COMPASSIONATE HEALTHCARE THAT IMPROVES THE OVERALL HEALTH OF OUR COMMUNITY.
2	Check this box
3	Number of voting members of the governing body (Part VI, line 1a).....	3	19
4	Number of independent voting members of the governing body (Part VI, line 1b) ....	4	14
5	Total number of individuals employed in calendar year 2011 (Part V, line 2a) ...	5	1,510
6	Total number of volunteers (estimate if necessary) ....	6	429
7a	Total unrelated business revenue from Part VIII, column (C), line 12 ..	7a	4,225,568
b	Net unrelated business taxable income from Form 990-T, line 34 ..	7b	404,871

		Prior Year	Current Year
8	Contributions and grants (Part VIII, line 1h) .........	1,191,113	1,579,559
9	Program service revenue (Part VIII, line 2g) .........	171,375,812	171,916,754
10	Investment income (Part VIII, column (A), lines 3, 4, and 7d ) ....	957,345	1,169,472
11	Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e)	5,397,185	5,129,572
12	Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12)...................	178,921,455	179,795,357
13	Grants and similar amounts paid (Part IX, column (A), lines 1–3 )...	27,690	22,900
14	Benefits paid to or for members (Part IX, column (A), line 4).....	0	0
15	Salaries, other compensation, employee benefits (Part IX, column (A), lines 5–10)	71,982,867	73,825,335
16a	Professional fundraising fees (Part IX, column (A), line 11e).....	0	0
b	Total fundraising expenses (Part IX, column (D), line 25) 0
17	Other expenses (Part IX, column (A), lines 11a–11d, 11f–24f)....	95,440,354	104,362,084
18	Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25)	167,450,911	178,210,319
19	Revenue less expenses. Subtract line 18 from line 12.......	11,470,544	1,585,038
		Beginning of Current Year	End of Year
20	Total assets (Part X, line 16).............	149,903,555	144,414,767
21	Total liabilities (Part X, line 26).............	121,387,527	150,978,640
22	Net assets or fund balances. Subtract line 21 from line 20.....	28,516,028	-6,563,873

Sign Here

	Signature of officer	Date

	Type or print name and title.


4a	(Code: ) (Expenses $ 150,256,042 including grants of $ 22,900 ) (Revenue $ 165,105,334 )
	Inpatient/Outpatient Services - SEE SCHEDULE O

4b	(Code: ) (Expenses $ 2,347,751 including grants of $ 0 ) (Revenue $ 2,618,590 )
	Rehabilitation Unit- THE GSH OPERATES A 14 BED REHABILITATION UNIT PROVIDING A FULL RANGE OF BASIC SERVICES REQUIRED BY AN ACUTE CARE REHAB PROGRAM INCLUDING PHYSICAL THERAPY, SPEECH THERAPY, OCCUPATIONAL THERAPY, SOCIAL SERVICES AND AUDIOLOGY. FY 6/30/12 STATISTICS: 373 REHAB ADMISSIONS AND 4,037 REHAB PATIENT DAYS.

4c	(Code: ) (Expenses $ 2,034,717 including grants of $ 0 ) (Revenue $ 2,161,447 )
	Skilled Nursing Facility- THE GSH OPERATES A 19 BED TRANSITIONAL CARE UNIT PROVIDING A FULL RANGE OF BASIC SERVICES REQUIRED BY A HOSPITAL BASED SKILLED NURSING FACILITY, INCLUDING PHYSICAL THERAPY, SPEECH THERAPY, OCCUPATIONAL THERAPY, SOCIAL SERVICES AND AUDIOLOGY. FY 6/30/12 STATISTICS: 364 TCU ADMISSIONS AND 3,948 TCU PATIENT DAYS.

4d	Other program services (Describe in Schedule O.)
	(Expenses $ 1,878,200 including grants of $ 0 ) (Revenue $ 2,031,384 )
4e	Total program service expenses$ 156,516,710

(A) Name and Title	(B) Average hours per week (describe hours for related organizations in Schedule O)	(C) Position (do not check more than one box, unless person is both an officer and a director/trustee)
(A) Name and Title
(1) CAROL BLECKER TRUSTEE	1.0	X
(2) EARL H BRINSER TRUSTEE	1.0	X
(3) SLOAN CAPLAN TRUSTEE	1.0	X
(4) EVELYN C COLON TRUSTEE	1.0	X
(5) PAUL R DIGIACOMO TRUSTEE	1.0	X
(6) DONALD H DREIBELBIS SECOND VICE CHAIRMAN	1.0	X	X
(7) ROBERT J FUNK TRUSTEE	1.0	X
(8) ROBERT P HOFFMAN TRUSTEE	1.0	X
(9) JANE W JUPPENLATZ SECRETARY	1.0	X	X
(10) FREDERICK C LAURENZO TRUSTEE	1.0	X
(11) ROBERT J PHILLIPS TRUSTEE	1.0	X
(12) WILLIAM E SCHAEFFER JR MD TRUSTEE	1.0	X
(13) DENNIS L SHALTERS CHAIRMAN	1.0	X	X
(14) GALEN G WEABER TRUSTEE	1.0	X
(15) JOHN P WELCH MD FIRST VICE CHAIRMAN	1.0	X	X
(16) DEBORAH T WEAVER TRUSTEE	1.0	X
(17) FREDERICK S WOLFSON ESQ TREASURER	1.0	X	X

(A) Name and Title	(B) Average hours per week (describe hours for related organizations in Schedule O)	(C) Position (do not check more than one box, unless person is both an officer and a director/trustee)				(D) Reportable compensation from the organization (W- 2/1099-MISC)	(E) Reportable compensation from related organizations (W- 2/1099-MISC)	(F) Estimated amount of other compensation from the organization and related organizations
(A) Name and Title
(18) JULIE ZINSSER TRUSTEE	1.0	X
(19) ROBERT J LONGO PRES. & CEO	40.0	X	X			513,509	0	796
(20) KIMBERLY FEEMAN SENIOR VP & COO	40.0		X			285,238	0	0
(21) ROBERT J RICHARDS VP FINANCE & CFO	40.0		X			291,979	0	0
(22) JACQUELYN M GOULD VP OF NURSING	40.0			X		196,218	0	0
(23) JULIE MIKSIT VP CV SVCS & REHAB THERAPIES	40.0			X		173,693	0	0
(24) ROBERT D SHAVER MD VP MEDICAL AFFAIRS	40.0			X		335,676	0	0
(25) ELIZABETH MUHIIRE-NTAKI PHYSICIAN	40.0				X	168,981	0	0
(26) DARIA KOVARIKOVA PHYSICIAN	40.0				X	187,680	0	0
(27) BYARD YODER PHYSICIAN	40.0				X	173,715	0	0
(28) ROBERTA SCHERR PHYSICIAN	40.0				X	169,280	0	0
(29) RICHARD FOLLETT CHIEF INFORMATION OFFICER	40.0				X	165,015	0	0

1b	Sub-Total................
c	Total from continuation sheets to Part VII, Section A....
d	Total (add lines 1b and 1c)............	2,660,984	0	796

				(A) Total revenue	(B) Related or exempt function revenue	(C) Unrelated business revenue	(D) Revenue excluded from tax under sections 512, 513, or 514
1a	Federated campaigns..1a
b	Membership dues....1b
c	Fundraising events....1c
d	Related organizations...1d		500,000
e	Government grants (contributions)1e		203,968

f	All other contributions, gifts, grants, and similar amounts not included above1f		875,591
g	Noncash contributions included in lines 1a-1f:$
h	Total. Add lines 1a-1f.......			1,579,559
			Business Code
2a	IP/OP PATIENTS		900,099	160,879,765	160,879,765
b	REHAB PATIENTS		900,099	2,618,590	2,618,590
c	HH/VNA SERVICES		621,610	2,031,384	2,031,384
d	TCU PATIENTS		900,099	2,161,447	2,161,447
e	DROP LAB REVENUE		621,500	4,225,568		4,225,568
f	All other program service revenue .
g	Total. Add lines 2a–2f........			171,916,754
3	Investment income (including dividends, interest
	and other similar amounts).....			747,021			747,021
4	Income from investment of tax-exempt bond proceeds..			117,451			117,451
5	Royalties............			0
		(i) Real	(ii) Personal
6a	Gross rents	129,483
b	Less: rental expenses	244,158
c	Rental income or (loss)	-114,675
d	Net rental income or (loss).......			-114,675			-114,675
		(i) Securities	(ii) Other
7a	Gross amount from sales of assets other than inventory	10,685,869
b	Less: cost or other basis and sales expenses	10,353,674	27,195
c	Gain or (loss)	332,195	-27,195
d	Net gain or (loss)..........			305,000			305,000
8a	Gross income from fundraising events (not including $ of contributions reported on line 1c). See Part IV, line 18 ...
	a
b	Less: direct expenses ...b
c	Net income or (loss) from fundraising events..			0
9a	Gross income from gaming activities. See Part IV, line 19 ...
	a
b	Less: direct expenses ...b
c	Net income or (loss) from gaming activities...			0
10a	Gross sales of inventory, less returns and allowances .
	a
b	Less: cost of goods sold ..b
c	Net income or (loss) from sales of inventory..			0
Miscellaneous Revenue			Business Code
11a	MALPRACTICE INSURANCE		524,298	969,890	969,890
b	PENSION INCOME		524,292	670,178			670,178
c	SNACK BAR/CAFE SALES		722,210	582,040			582,040
d	All other revenue ....			3,022,139	3,022,139
e	Total. Add lines 11a–11d ......			5,244,247
12	Total revenue. See Instructions....			179,795,357	171,683,215	4,225,568	2,307,015


				(A) Beginning of year		(B) End of year
1	Cashnon-interest-bearing ..........			5,370	1	5,220
2	Savings and temporary cash investments .......			2,403,439	2	2,272,501
3	Pledges and grants receivable, net .........			1,373,674	3	1,029,573
4	Accounts receivable, net .........			18,802,608	4	18,637,951
5	Receivables from current and former officers, directors, trustees, key employees, and highest compensated employees. Complete Part II of
	Schedule L ..........			0	5	0
6	Receivables from other disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B). Complete Part II of
	Schedule L ..........			0	6	0
7	Notes and loans receivable, net .............			1,153,750	7	1,130,188
8	Inventories for sale or use ..............			1,656,440	8	1,686,147
9	Prepaid expenses and deferred charges ............			2,464,927	9	2,851,253
10a	Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D	10a	186,994,825
b	Less: accumulated depreciation. .....	10b	117,407,607	73,244,003	10c	69,587,218
11	Investments—publicly traded securities ..........			29,142,551	11	29,850,306
12	Investments—other securities. See Part IV, line 11 ......			0	12	0
13	Investments—program-related. See Part IV, line 11 ..			0	13	0
14	Intangible assets .........			2,269,669	14	2,269,669
15	Other assets. See Part IV, line 11 ...........			17,387,124	15	15,094,741
16	Total assets. Add lines 1 through 15 (must equal line 34)...			149,903,555	16	144,414,767
17	Accounts payable and accrued expenses .			13,289,408	17	18,574,578
18	Grants payable ..........			0	18	0
19	Deferred revenue ..........			327,222	19	375,508
20	Tax-exempt bond liabilities ..........			65,273,066	20	63,955,676
21	Escrow or custodial account liability. Complete Part IV of Schedule D..			0	21	0
22	Payables to current and former officers, directors, trustees, key employees, highest compensated employees, and disqualified
	persons. Complete Part II of Schedule L..........			0	22	0
23	Secured mortgages and notes payable to unrelated third parties ..			791,851	23	700,819
24	Unsecured notes and loans payable to unrelated third parties ....			3,593,583	24	2,871,683
25	Other liabilities (including federal income tax, payables to related third parties, and other liabilities not included on lines 17-24). Complete Part X of Schedule D.....			38,112,397	25	64,500,376
26	Total liabilities. Add lines 17 through 25.....			121,387,527	26	150,978,640
	Organizations that follow SFAS 117, check here and complete lines 27 through 29, and lines 33 and 34.
27	Unrestricted net assets .....			25,570,795	27	-9,283,282
28	Temporarily restricted net assets .....			2,273,056	28	2,047,232
29	Permanently restricted net assets .....			672,177	29	672,177
	Organizations that do not follow SFAS 117, check here and complete lines 30 through 34.
30	Capital stock or trust principal, or current funds .....				30
31	Paid-in or capital surplus, or land, building or equipment fund .....				31
32	Retained earnings, endowment, accumulated income, or other funds				32
33	Total net assets or fund balances .....			28,516,028	33	-6,563,873
34	Total liabilities and net assets/fund balances .....			149,903,555	34	144,414,767